memperingati maulid nabi muhammad SAW.

 

Mmbuka pendaftaran Santri baru Tahun Ajaran 2020/2021

 

المعهد الاسلامى السلفى حكمة المهاجرين

PON – PES HIKMATUL MUHAJIRIN

“HIKMATUL MUHAJIRIN”

JL. KYAI THOBRONI, NO. 76  DESA PRAMBON, KEC. DAGANGAN,KAB. MADIUN. Kode pos 63172

Website :  www.pon-peshikmatulmuhajirin.com

بِسْمِ اللهِ الرَّحْمَنِ الرَّحِيْمِ

FORMULIR PENDAFTARAN SANTRI BARU

PONDOK PESANTREN  HIKMATUL MUHAJIRIN

 

NAMA LEMBAGA                 : Pon - Pes Hikmatul Muhajirin

NOMOR PENDAFTARAN      :_______

 

1.    BIODATA SANTRI

A.     Nama Santri                                         : ..............................................................................................

B.      Tempat  Tanggal Lahir                         : ..............................................................................................

C.      Jenis Kelamin                                             : ..............................................................................................

D.      Agama                                                        : ..............................................................................................

E.       Anak Ke                                                                                : ..............................................................................................

F.       Jumlah Saudara                                                  : ..............................................................................................

G.      Status Dalam Keluarga                                      : ..............................................................................................

H.      Alamat   Siswa                                                   : ..............................................................................................

                                                                                                  ..............................................................................................

I.        Telephone                                                             : ..............................................................................................

J.        Pendidikan Terahir                                              : ..............................................................................................

 

2.    ORANG TUA / WALI

 

A.     Nama Ayah                                         : ..............................................................................................

B.     Tempat tanggal lahir                            : ..............................................................................................

C.     Pekerjaan                                             : ..............................................................................................

D.     Pendidikan terakhir                              : ..............................................................................................

E.      Alamat                                                 : ..............................................................................................

F.      No telp                                                 : ..............................................................................................

 

A.     Nama Ibu                                             : ..............................................................................................

B.     Tempat tanggal lahir                            : ..............................................................................................

C.     Pekerjaan                                             : ..............................................................................................

D.     Pendidikan terakhir                              : ..............................................................................................

E.      Alamat                                                 : ..............................................................................................

F.      No telp                                                 : ..............................................................................................

 

WALI DAN PERWALIAN

A.           Nama Wali                                                    : ..............................................................................................

B.      Alamat Wali                                                   : ..............................................................................................

C.      Telephone                                                       : ..............................................................................................

D.     Pekerjaan Wali                                              : ..............................................................................................

Kriteria Keluarga                                             : sejahtera / pra sejahtera / miskin / yatim piatu

Madiun,....,................,2020/2021

Mengetahui

Orang tua/wali       (...............................................................) Nama terang	Calon siswa       (......................................................................) Nama terang
Pengurus Pon-Pes Hikmatul Muhajirin,       (___________________)

Nama Petugas Pendaftaran

 

·         Menyertakan Fotocopy KK ( 2 Lembar )

·         Menyertakan Fotocopy AKTE Kelahiran ( 2 Lembar )

·         Menyertakan Fotocopy KTP Kedua Orang Tua ( 2 Lembar )

·         Menyertakan Fotocopy KIP Dan KIS (  Masing – Masing 2 Lembar ), Jika Memiliki

Kegiatan Mingguan Forum exspresi

\

 

kegiatan forum expresi dan sanggar tresna kriya