7/24/2019 Formulir Ppdb 2015 2016
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PEMERINTAH KOTA PAREPAREDINAS PENDIDIKAN
SMA NEGERI 5 UNGGULAN KOTA PAREPAREAlamat : Jl. Kelapa Gading
No. 69 Telp (0421) 3310834 Paepae
ppd!"#man$paepae.!log#pot.%om & email :
#man$paepae'lie.%om
FORMULIR PENDAFTARAN CALON PESERTA DIDIK BARU
SMA NEGERI 5 UNGGULAN PAREPARETAHUN PELAJARAN 2015/2016
Nomo *t +om*li : ................, Nomo -egi#ta#i e! : /////.,
dii#i ole
Panitia
Nama alon :
...............................................................................................
Jeni# Kelamin : & P) Nomo nd*5 i#7a
Na#ional.................................:
Tempat & Tanggal ai :
...............................................................................................
Agama : ...................... A#al e5ola
(P&T#).................................:
Alamat -*ma :
...............................................................................................
Alamat e5ola A#al :
...............................................................................................
No. Telp & P : ........................ mail :
.........................................................
Pen;a5it ;g pena
dideita.............................................................................................
:
Nilai -ata < -ata -apot etiap eme#te
eme#te : ......................
eme#te : ......................
eme#te : ......................
eme#te = : ......................
eme#te = : ......................
Peminatan : Pilian 1 : PA & o#ial & >aa#a) Pilian 2 :
PA & o#ial &>aa#a)
Nama ?ang T*a & ali :
...............................................................................................
Pe5e@aan ?ang T*a & ali
:..............................................................................................
Alamat ?ang T*a & ali :
...............................................................................................
No. Telp&P ?ang T*a &
ali...................................:
apat nBo A Negei $ dai .................................: Teman,
*at Ka!a, ntenet,lainn;a)
LAMPIRKAN SOFTCOPY (FILE) :1. +oto%op; -apo eme#te < = ;ang
Tela ilegali#i alon i#7a,2. +oto%op; Kat* Nomo nd*5 i#7a Na#ional
(NN)3. +oto%op; etiC5at & Piagam om!a ;ang Pena ii5*ti4. +oto 3
D 4 %m >e7ana 1 em!a$. ap Pla#ti5 ea *nt*5 alon a5i"la5i (di!a7a
#aat #ele5#i)6. ap Pla#ti5 K*ning *nt*5 %alon Peemp*an (di!a7a #aat
#ele5#i)
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... dii#i dengan mengg*na5an **B KAPTA, Bom*li ini dapat
diganda5an, 5iim 5e :!"#5$"%&$"%&'*&+,-!
N" R"." R"." S&! I
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