SIDIAUNESA.AC.ID
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Formulir Penerimaan Peserta Didik Baru Tahun 2023
Registrasi Peserta Didik
Jenis Pendaftaran:

Baru / Pindahan

Jalur Pendaftaran:.................................................................................................................

Nomor Pendaftaran:....................................................................................... ( Diisi Panitia )Tanggal Pendaftaran:....................................................................................... ( Diisi Panitia )Pilihan I:.................................................................................................................

Pilihan II:.................................................................................................................

Nama Sekolah Asal:.................................................................................................................

Alamat Sekolah Asal:.................................................................................................................

Nama Lengkap:.................................................................................................................

Jenis Kelamin:Laki-laki / PerempuanNIK:.................................................................................................................

Tempat Lahir:.................................................................................................................

Tanggal Lahir:.................................................................................................................

Agama:

Budha / Hindu / Islam / Katholik / Khong Hu Chu / Kristen /protestan / Lainnya

Kebutuhan Khusus:

Autis / Bakat Istimewa / Cerdas Istimewa / Down Sindrome /Hiper aktif / Indigo / Kesulitan Belajar / Lainnya / Narkoba / Tidak/ Tuna Daksa Ringan / Tuna Daksa Sedang / Tuna ganda / Tuna
Grahita ringan / Tuna Grahita Sedang / Tuna Laras / Tuna Netra /Tuna Rungu / Tuna Wicara

Alamat Jalan:.................................................................................................................

RT:.................................................................................................................

RW:.................................................................................................................

Dusun:.................................................................................................................

Kelurahan / Desa:.................................................................................................................

Kecamatan:.................................................................................................................

Kota/Kabupaten:.................................................................................................................

Kode Pos:.................................................................................................................

Email:.................................................................................................................

Biodata Peserta Didik

AlamatSaya yang bertandatangan dibawah ini menyatakan bahwa data yang tertera diatas adalah yang sebenarnya.
.............................................., ............. .................................... 2023....................................................................

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Dicetak tanggal 07 Oktober 2024 pukul 11:27:12