No. Pendaftaran:
FORM A.1 | 2013
MA'HAD AL-ITTIHAD AL-ISLAMI
FORMULIR PENDAFTARAN SANTRI BARU ISLAMI TERPERCAYA KOMPETITIF
NAMA
: ____________________________________
ALAMAT : ____________________________________ : ____________________________________
SURAT PERMOHONAN MENJADI SANTRI Kepada Yth. Bapak Pimpinan Ma’had Al-Ittihad Al-Islami Camplong di-TEMPAT
Dengan hormat, yang bertanda tangan di bawah ini, saya: Nama Lengkap
: _______________________________________________________________
Tempat / Tanggal Lahir : _______________________________________________________________ Alamat
: _______________________________________________________________ : _______________________________________________________________
dengan segala kerendahan hati dan penuh harapan memohon kepada Bapak untuk diterima menjadi santri Ma’had Al-Ittihad Al-Islami Camplong Tahun Pelajaran 2013-2014. Dan sesuai dengan ketentuan-ketentuan yang berlaku, maka dengan sepenuh hati saya berjanji untuk: a.
Mematuhi ketentuan pembayaran yang telah ditetapkan oleh Ma’had, baik pada waktu pendaftaran ataupun setiap bulannya.
b.
Memenuhi dan menjalankan JANJI SANTRI sebagai berkut: 1.
Percaya dan taat sepenuhnya kepada peraturan Ma’had dan sanggup melaksanakan semua bimbingan dengan sebaik–baiknya.
2.
Sanggup berpegang teguh kepada prinsip–prinsip pendidikan di Ma’had Al-Ittihad Al-Islami Camplong dan bersedia mengikuti semua disiplin/tata tertib yang berlaku di dalam Ma’had.
3.
Bersedia menerima segala macam tindakan yang diberikan oleh atau atas nama Pimpinan Ma’had untuk kebaikan bersama.
Demikian surat permohonan ini saya sampaikan, kiranya dapat diterima. Amin.
Camplong, ………..……………………….2013 Ikut memohon, Orangtua / Wali
Calon Santri,
(…………………..……………………………….)
(…………………..……………………………….)
FORM B.1 | 2013
No. Pendaftaran:
DATA PRIBADI
* Diisi panitia ** Coret yang tidak perlu *** Kosongi bila tidak ada
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DATA PENDIDIKAN yUhRiwayathpendidikan hhhaUh_________________________________________________________hscdhkelashh_______________hbberijazahhchtidakAA0 hhhbUh_________________________________________________________hscdhkelashh_______________hbberijazahhchtidakAA0 hhhcUh_________________________________________________________hscdhkelashh_______________hbberijazahhchtidakAA0 OUhPindahanh hhhhaUhDarihSekolah
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FORM B.2 | 2013
No. Pendaftaran:
DATA PRIBADI
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CalonySantrib
ky____________________________________6
ky____________________________________6
BLANGKO TES MINAT DAN KONSEP PRIBADI SANTRI BARU
No. Pendaftaran:
FORM-C78-|-,I89
PETUNJUK UMUM : Isilah pertanyaan dan pernyataan di bawah ini dengan HURUF BALOK
ﺑﺴ ﻢ ﺍﷲ ﺍﻟﺮﺣ ﻤﻦ ﺍﻟﺮﺣﻴ ﻢ KELOMPOK SOAL A 87-Data-Calon-Santri NamayLengkap NamayPanggilan Tempat)TanggalyLahir AlamatyAsal BahasaySehari1hari
:y__________________________________________________________________ :y__________________________________________________________________ :y_ :y______________________________yyyM :y__________________________________________________________________ :y__________________________________________________________________ :y__________________________________________________________________
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BLANGKO TES MINAT DAN KONSEP PRIBADI SANTRI BARU
No. Pendaftaran:
FORMeCc8e|e8-I9
I9ceApaebidangestudieyangepalingetidakeAndaesukai? 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SSSSSSS-GSAndaStinggalSbersamaSSSSS:SLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL SSSSSSS2GSStatusSrumahSSSSSSSSSSSSSSSSSSSSSS:SMilikSsendiriSPSMenyewaSPSKontrakSPSDinasSPSAsrama SSSSSSS3GSKeadaanSrumahSSSSSSSSSSSSSSSSS:SBesarSPSSedangSPSKecil SSSSSSS4GSBahanSrumahSSSSSSSSSSSSSSSSSSSSSS:STembokSPSSetengahStembokSPSBambuSAnyam(GedhekPTabingG SSSSSSS5GSSuasanaSrumahSSSSSSSSSSSSSSSSSS:STenangSPSCukupSPSRamai SSSSSSS6GSLingkunganSrumahSSSSSSSSSSS:SDekatStempatSibadahSPSPertokoanSPSTempatSHiburanSPSPerkampunganSPS SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSDaerahShitamSPSDaerahSPelajar I7ceApaerencanaeAndaesetelahemenjadiesantriediePesantreneAl7IttihadeAl7IslamieCamplongeini? SSSSSSS-GSLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL SSSSSSS2GSLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL SSSSSSS3GSLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL I8ceApaerencanaeAndaesetelahetamatebelajaredariePesantreneAl7IttihadeAl7IslamieCamplongeini? SSSSSSSMelanjutkanSkeSperguruanStinggiSSSSSSSSSSSSSSSMencariSpekerjaanPBekerjaSSSSSSSSSSSSSSSMengikutiSkursus6kursusSuntukSbekerja SSSSSSSMembantuSpekerjaanSorangtuaSSSSSSSSSSSSSSSSSSBelumSmempunyaiSrencana I9ceApaecita7citaeAndaeuntukekehidupaneyangeakanedatang? SSSSSSS-GSLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL SSSSSSS2GSLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL SSSSSSS3GSLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL 8-ceMenurutepikiraneAndaesekarangBekesuliataneapakaheyangemungkinetimbuledalamemencapainya?e SSSSSSS-GSLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL SSSSSSS2GSLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL SSSSSSS3GSLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
BLANGKO TES MINAT DAN KONSEP PRIBADI SANTRI BARU
No. Pendaftaran:
FORM C.3 | 2013
KELOMPOK SOAL B BubuhkanjhurufjSj(Sering),jJj(Jarang),jHTPj(Hampirjtidakjpernah)jdanjPj(pernah)jpadajkotakjyangjtersedia! htp Contoh:jjjjjjjjjjjjjjjO,BjMerokok O,BjMerokok
GO,BjInginjmenirujgayajiklanIfilmjdijTVIBioskop
G,BjSukajminumjminumanjkeras
GG,BjKurangjbahagiajkarenajcacatjjasmaniIrohani
U,BjMempunyaijpenyakitjmenular
GU,BjMerasajterpengaruhjsekalijolehjadeganjseks
z,BjSukajmengganggujorangjlain
jjjjjjjjjdalamjbukuVbukujTVIBioskop
Y,BjMerasajsulitjuntukjmeninggalkanjhobby
Gz,BjBeranijkejOrangtua
jjjjjjjyangjkurangjsehat
GY,BjBeranijkejGuruIUstadz
E,BjSukajmenontonjfilmIbioskopImainjgame
GE,BjSeringjmerasajtakutItertekanjdenganj
R,BjSukajmengambiljuangjkeluargajtanpajijin
jjjjjjjjjperaturanjorangtua
J,BjMempunyaijdoronganjuntukjberdustaI
GR,BjSulitjuntukjbelajarjteratur
jjjjjjberbuatjtidakjjujur
GJ,BjMerasajsangatjperluIpentingjdenganjilmujagama
N,BjTidakjsadarjmengambiljbarangjorangjlain
GN,BjSukajmeremehkanjorangjberbicara
O-,BjMerasajseringjmenyakitijorangjlain
U-,BjSeringjpergijtanpajpamitjkepadajorangtua
OG,BjMerasajdimanjajolehjorangtuaj
UO,BjMinderItidakjpercayajdirijjikajberbicara
OU,BjMerasajdiabaikanjolehjorangtuaj
jjjjjjjjjdijdepanjumum
Oz,BjKeluargajhidupjberantakanjcperceraianwj
UG,BjBanggajdenganjkeberadaanjAyah
jjjjjjjjjmeninggaljduniawjpermaduanwjcekcok,j
UU,BjBanggajdenganjkeberadaanjIbu
OY,BjMerasajmalasjuntukjsekolahjSMPISMAj
Uz,BjSukajhidupjsehatIbersih
OE,BjMerasajmalasjbelajarjdijPesantrenj
UY,BjSukajbersolekIberdandan
OR,BjPilihankujbelajarjtakjsesuaijdengan
UE,BjAdajkeinginanjmencobaVcobajmodej
jjjjjjjjjpilihanjorangtuaj
jjjjjjjjjpakaianIbarangjbaru
OJ,BjMerasajmulaijmencintaijseseorang
UR,BjSukajbelanjajbarangjyangjtakjdiperlukanjcboros,j
ON,BjMerasajmulaijdicintaijseseorang
UJ,BjPernahjtawuran
G-,BjMerasajkhawatirjterhadapjakibatjdarij
UN,BjPernahjjadijjuarajcsebutkanjdijbarisjbawah:,
jjjjjjjjjadeganIacarajpercintaanjdijTVIBioskop Daftarjjuara: O,jBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBwjjjjjjjG,jBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB U,jBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBwjjjjjjjz,jBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 21. Tulislah ulang pernyataan berikut ini dengan tanganmu sendiri! jjjjjjjO,jSAYAjBERJANJIjTIDAKjAKANjMEROKOK BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB jjjjjjjG,jSAYAjBERJANJIjDISIPLINjIBADAHjDANjBELAJAR BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
BLANGKO TES MINAT DAN KONSEP PRIBADI SANTRI BARU
No. Pendaftaran:
FORM3C.43|32013
21.3Tulislah3ulang3pernyataan3berikut3ini3dengan3tanganmu3sendiri!3(Lanjutan...) PPPPPPP3ZPSAYAPBERJANJIPAKANPPATUHPDANPTAATPTERHADAPPBIMBINGANPWPPEMBINAANPYANGPDIBERIKANPOLEHP PPPPPPPPPPPPPENGURUSPPESANTRENPDANPASATIDZ ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ PPPPPPP4ZPSAYAPAKANPMENERIMAPHUKUMANPDENGANPIKHLASWPAPABILAPSAYAPMELANGGARPTATAPTERTIBPPESANTREN ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ PPPPPPP5ZPSESUNGGUHNYAPIBADAHKUWPHIDUPKUPDANPMATIKUPHANYALAHPMILIKPALLAHPSWTPSEMATA ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ ........................................................................................................................................................................................................
CamplongWP...................................................P2013 CalonPSantriW
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