JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Formulir PPDB TP 2016/2017
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Nama lengkap
*
Your answer
Jenis Kelamin
*
Choose
Laki-laki
Perempuan
NIK (Sesuai dengan Kartu Keluarga)
*
Your answer
Tempat Lahir
*
Your answer
Tanggal Lahir
*
MM
/
DD
/
YYYY
Agama
*
Choose
Islam
Kristen/ Protestan
Katholik
Hindu
Khong Hu Chu
Lainnya
Berkebutuhan Khusus
*
Choose
Tidak,
Netra(A),
Rungu(B),
Grahita Ringan(C),
Grahita Sedang(C1),
Daksa Ringan(D),
Daksa Sedang(D1),
Laras(E)
Wicara(F),
Tuna Ganda(G),
Hyperaktif(H) ,
Cerdas Istimewa(I),
Bakat Istimewa(J),
Kesulitan Belajar(K),
Narkoba(N)
Indigo(0),
Down Syndrome(P),
Autis(Q),
Terpencil/Terbelakang,
Bencana Alam/Sosial,
Tidak Mampu Ekonomi
Alamat Tempat Tinggal
*
Your answer
Dusun
Your answer
Kelurahan/ Desa
*
Your answer
Kecamatan
*
Your answer
Kabupaten/ Kota
*
Your answer
Provinsi
*
Your answer
Alat transportasi ke sekolah
*
Choose
Jalan Kaki
Kendaraan Pribadi
Kendaraan Umum/Angkot/Pete-pete
Jemputan Sekolah
Kereta Api
Ojek
Andong/Bendi/Sado/Dokar/Delman/Becak
Perahu Penyebrangan/Rakit/Getek
Lainnya
Jenis Tinggal
*
Choose
Bersama Orang Tua
Wali
Panti Asuhan
Lainnya
No. Telepon Rumah
Your answer
No. Hp
Nomor Hp Orang tua/wali
Your answer
Email pribadi
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
