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Formulir Penerimaan Peserta Didik Baru (PPDB) SMP Kartini 1 Batam TA. 2023/2024
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Nama Lengkap
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Jenis Kelamin
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Laki - Laki
Perempuan
NISN
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Kewarganegaraan
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NIK
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No.KK
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Tempat Lahir
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Tanggal Lahir
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MM
/
DD
/
YYYY
No. Regestrasi lahir
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Email
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No Tlp/WA
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Asal Sekolah
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Berkebutuhan Khusus (Siswa)
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Netra ( A )
Rungu ( B )
Grahita Ringan ( C )
Grahita Sedang (C1)
Daksa Ringan ( D )
Daksa Sedang ( D1)
Laras ( E )
Wicara ( F )
Hyperaktif ( H )
Cerdas Istimewa ( I )
Bakat Istimewa ( J )
Kesulitan Belajar ( K )
All of the above
Agama&Kepercayaan
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Islam
Kristen
Katholik
Hindu
Budha
Khonghucu
Alamat
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RT
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RW
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Desa/Kelurahan
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Kecamatan
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Kode Pos
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Tempat Tinggal
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Bersama Orang Tua
Wali
Kost
Asrama
Panti Asuhan
Pesantren
Lainnya
Moda Transportasi
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Jalan Kaki
Mobil Pribadi
Sepeda Motor
Ojek
Angkutan Umum / BUS
Sepeda
Kuda
Anak Ke-berapa (Berdasarkan KK)
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1
2
3
4
5
6
7
8
9
10
No.KIP(Kartu Indonesia Pintar)
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Tingggi Badan
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Berat Badan (Kg)
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Lingkar Kepala (Cm)
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Jarak Rumah Kesekolah (KM)
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Jumlah Saudara Kandung
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1
2
3
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6
7
8
9
10
Tidak Punya
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