YAYASAN MADRASAH AL-BAYAN
RAUDHATUL ATHFAL ( RA ) SWASTA AL-BAYAN
NAGORI PARBUTARAN
KECAMATAN BOSAR MALIGAS KABUPATEN SIMALUNGUN PROV.SUMATERA UTARA Kodepos 21183
FORMULIR PENDAFTARAN SANTRI BARU
TAHUN AJARAN 2016 / 2017
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A. DATA PRIBADI CALON SANTRI
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1
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NAMA LENGKAP
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: ........................................................................
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2
|
NAMA PANGGILAN
|
: ........................................................................
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3
|
JENIS KELAMIN
|
: ........................................................................
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4
|
TEMPAT / TGL.LAHIR
|
: ........................................................................
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5
|
AGAMA
|
: ........................................................................
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6
|
ANAK KE
|
: ........................................................................
| ||||
7
|
JUMLAH SAUDARA
|
: ........................................................................
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8
|
ALAMAT SANTRI
|
: ........................................................................
| ||||
B. DATA ORANG TUA / WALI
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DATA AYAH
|
DATA IBU
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1
|
NAMA LENGKAP
|
......................................
|
......................................
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2
|
TEMPAT LAHIR
|
......................................
|
......................................
| |||
3
|
TANGGAL LAHIR
|
......................................
|
......................................
| |||
4
|
AGAMA
|
......................................
|
......................................
| |||
5
|
PENDIDIKAN
|
......................................
|
......................................
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6
|
PEKERJAAN
|
......................................
|
......................................
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7
|
PENGHASILAN/BULAN
|
......................................
|
......................................
| |||
8
|
ALAMAT ORANG TUA
|
......................................
|
......................................
| |||
C. PERSYARATAN
1. Uang Pasphoto 3 x 4 – 2 Lembar : Rp._____________________
2. Fotocopy Kartu Keluarga
3. Uang Pendaftaran : Rp._____________________
4. No.HP Orang Tua/Wali Santri : Rp._____________________
Mengetahui/Menyetujui Parbutaran, 2016
Orang Tua / Wali Santri Petugas Pendaftaran
...................................... ......................................
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