Pribadi Bandung Online Application Form

AddressAlamat

Where does the student live?Alamat tempat tinggal siswa

An address we can use for correspondence.Alamat yang bisa kami gunakan untuk korespondensi.

Located in IndonesiaBerada di Indonesia

Street AddressAlamat Jalan *

Street, RT/RW, village, districtJalan, RT/RW, kelurahan, kecamatan

City / RegencyKota / Kabupaten *

ProvinceProvinsi OptionalOpsional

Postal CodeKode Pos OptionalOpsional

Student Phone NumberNo. Telepon Siswa OptionalOpsional

Education's InformationPendidikan

Current schoolSekolah asal

The school the student attends now.Sekolah tempat siswa belajar saat ini.

Current School NameNama Sekolah Sekarang OptionalOpsional

School's Street AddressAlamat Jalan Sekolah OptionalOpsional

Current GradeKelas Sekarang OptionalOpsional

School located in IndonesiaSekolah berada di Indonesia

School's CityKota Sekolah OptionalOpsional

School's ProvinceProvinsi Sekolah OptionalOpsional

School's Postal CodeKode Pos Sekolah OptionalOpsional

Parent/Guardian's InformationData Orang Tua / Wali

Parents / guardianData orang tua / wali

The confirmation is sent to the parents' email and WhatsApp.Konfirmasi pendaftaran dikirim ke email dan WhatsApp orang tua.

FatherAyah

Father's NameNama Ayah *

Father's EmailEmail Ayah *

Father's Phone NumberNo. Telepon Ayah * This number is also on WhatsAppNomor ini juga WhatsApp

Father's Date of BirthTanggal Lahir Ayah OptionalOpsional

Father's NationalityKewarganegaraan Ayah *

Father's EducationPendidikan Terakhir Ayah OptionalOpsional

Father's OccupationPekerjaan Ayah *

Father's Company or InstitutionPerusahaan / Institusi Ayah OptionalOpsional

Father's PositionJabatan Ayah OptionalOpsional

Father's IncomePenghasilan Ayah *

Father's Office AddressAlamat Kantor Ayah OptionalOpsional

Father's Office PhoneNo. Telepon Kantor Ayah OptionalOpsional

MotherIbu

Mother's NameNama Ibu *

Mother's EmailEmail Ibu *

Mother's Phone NumberNo. Telepon Ibu * This number is also on WhatsAppNomor ini juga WhatsApp

Mother's Date of BirthTanggal Lahir Ibu OptionalOpsional

Mother's NationalityKewarganegaraan Ibu *

Mother's EducationPendidikan Terakhir Ibu OptionalOpsional

Mother's OccupationPekerjaan Ibu OptionalOpsional

Mother's Company or InstitutionPerusahaan / Institusi Ibu OptionalOpsional

Mother's PositionJabatan Ibu OptionalOpsional

Mother's IncomePenghasilan Ibu OptionalOpsional

Mother's Office AddressAlamat Kantor Ibu OptionalOpsional

Mother's Office PhoneNo. Telepon Kantor Ibu OptionalOpsional

FamilyKeluarga

Family Card / ITAS / SKTT NumberNo. Kartu Keluarga / ITAS / SKTT OptionalOpsional

InterviewWawancara

Choose a slot for the online interviewPilih jadwal wawancara daring

Pick a date, then a time.Pilih tanggal, lalu jam.

DateTanggal *

Another date:Tanggal lain:

Time (WIB)Jam (WIB) *

DocumentsDokumen

Upload documentsUnggah dokumen

Phone photos are fine as long as they are readable. Large photos are made smaller automatically, and files stay saved in this browser until you submit.Foto dengan kamera ponsel juga boleh, asalkan jelas terbaca. Foto besar otomatis diperkecil, dan berkas tetap tersimpan di browser ini sampai formulir dikirim.

JPG, PNG, PDF, Word or Excel · max. 5 MB per file.Format JPG, PNG, PDF, Word atau Excel · maks. 5 MB per berkas.

ReviewTinjauan

Check your answersPeriksa kembali data Anda

Make sure everything is correct. After you submit, changes can only be made through the school.Pastikan semua data sudah benar. Setelah dikirim, perubahan hanya bisa dilakukan melalui sekolah.

I confirm that the information I have given is true and correct.Saya menyatakan data yang saya isi benar dan dapat dipertanggungjawabkan.