FORMULIR ANAK BARU SEKOLAH DASAR

FORMULIR MURID BARU

NOMOR INDUK .............................(Disi oleh Sekolah)

A.       Keterangan Murid

1. Nama Murid          a. Lengkap                : ........................................................................

b. Panggilan             : ........................................................................

2. Jenis Kelamin                                          : ........................................................................

3. Kelahiran              a. Tanggal                 : ........................................................................

                                    b. Tempat                   : ........................................................................

4. Agama                                                       : ........................................................................

5. Kewarga Negaraan                                 : WNI / WNA Keturunan * )

6. Jumlah Saudara a. Kandung                : ........................................................................

                                    b. Tiri                          : ........................................................................

                                    c. Angkat                   : ........................................................................

7. Bahasa sehari – hari                              : ........................................................................

8. Keadaan Jasmani                                  

                                    a. Berat                      : ........................................................................

                                    b. Tinggi badan        : ........................................................................

                                    c. Golongan darah   : ........................................................................

                                    d. Penyakit yang

                                        pernah di derita    : ........................................................................

9. Alamat & No telp                                      : ........................................................................

10 bertempat tinggal pada                          : Orang tua / Menumpang / asrama * )

11. Jarak tempat tinggal ke sekolah         : ........................................................................

B. Keterangan orang tua / Wali Murid

1. a. Nama                 1. Ayah / Umur         : ........................................................................

                                    2. Ibu / Umur             : ........................................................................

     b. Pendidikan Tertinggi

                                    1. Ayah                      : ........................................................................

                                    2. Ibu                          : ........................................................................

     c. Pekerjaan         1. Ayah                      : ........................................................................

                                    2. Ibu                          : ........................................................................

     d. Wali Murid ( Jika mempunyai )         : ........................................................................

            b. Pindah dari sekolah lain

            1. Nama sekolah asal                     : ........................................................................

            2. Dari tingkat                                   : ........................................................................

            c. Diterima

            1. Tanggal                                         : ........................................................................

            2. Tingkat                                           : ........................................................................

Kasikan,                                               2019

               Orang Tua/  Wali Murid

              ------------------------------------- 

*) Coret yang tidak perlu