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www.ppdb.smansakuba.sch.id Open in urlscan Pro
217.21.73.191  Public Scan

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URL: https://www.ppdb.smansakuba.sch.id/
Submission: On June 21 via api from US — Scanned from SG

Form analysis 1 forms found in the DOM

POST https://www.ppdb.smansakuba.sch.id/daftar/submit

<form class="form-horizontal parsley-form" method="POST" action="https://www.ppdb.smansakuba.sch.id/daftar/submit" enctype="multipart/form-data" id="formdaftar">
  <div class="panel panel-info" id="1">
    <header class="panel-heading"> Data Calon Peserta Didik </header>
    <div class="panel-body">
      <div class="col-sm-6">
        <table class="table table-responsive" width="100%">
          <tbody>
            <tr>
              <td style="vertical-align: middle" width="30%">Nama Lengkap</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="nama" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^a-zA-Z ]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle">Jenis Kelamin</td>
              <td style="vertical-align: middle">:</td>
              <td style="vertical-align: middle" width="69%">
                <select required="" class="form-control selectoption valselect" name="jeniskelamin" id="jeniskelamin" value="">
                  <option value="">Silahkan Pilih</option>
                  <option value="LAKI-LAKI">LAKI-LAKI</option>
                  <option value="PEREMPUAN">PEREMPUAN</option>
                </select>
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">NISN</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="nisn" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">NIK</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="nik" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Tempat Lahir</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="tempatlahir" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Tanggal Lahir</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="tanggallahir" class="form-control valinput selectdate" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Agama</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <select required="" class="form-control selectoption valselect" name="agama" id="agama" value="">
                  <option value="">Silahkan Pilih</option>
                  <option value="ISLAM">ISLAM</option>
                  <option value="KRISTEN">KRISTEN</option>
                  <option value="KATOLIK">KATOLIK</option>
                  <option value="HINDU">HINDU</option>
                  <option value="BUDHA">BUDHA</option>
                  <option value="KONGHUCU">KONGHUCU</option>
                  <option value="KEPERCAYAAN KEPADA TUHAN YME">KEPERCAYAAN KEPADA TUHAN YME</option>
                </select>
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Telepon</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="telepon" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">No HP</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="hp" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Email</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="email" class="form-control valinput" type="email" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">SKHUN</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="skhun" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Penerima KPS</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <select required="" class="form-control selectoption valselect" name="penerimakps" id="penerimakps" value="">
                  <option value="">Silahkan Pilih</option>
                  <option value="YA">YA</option>
                  <option value="TIDAK">TIDAK</option>
                </select>
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">No KPS</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="nokps" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Berat Badan (KG)</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="beratbadan" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Tinggi Badan (CM)</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="tinggibadan" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Kebutuhan Khusus</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="kebutuhankhusus" class="form-control valinput" type="text" value="">
              </td>
            </tr>
          </tbody>
        </table>
      </div>
      <div class="col-sm-6">
        <table class="table table-responsive" width="100%">
          <tbody>
            <tr>
              <td style="vertical-align: middle" width="30%">Alamat</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="alamat" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">RT</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="rt" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">RW</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="rw" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Dusun</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="dusun" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Kelurahan/Desa</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="kelurahandesa" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Kecamatan</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="kecamatan" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Kabupaten/Kota</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="kabupatenkota" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Provinsi</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="provinsi" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Kode Pos</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="kodepos" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Jenis Tinggal</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <select required="" class="form-control selectoption valselect" name="jenistinggal" id="jenistinggal" value="">
                  <option value="">Silahkan Pilih</option>
                  <option value="BERSAMA ORANGTUA">BERSAMA ORANGTUA</option>
                  <option value="BERSAMA WALI">BERSAMA WALI</option>
                </select>
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Alat Transportasi</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="alattransportasi" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Jarak Rumah ke Sekolah</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="jarakrumahsekolah" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Waktu Tempuh ke Sekolah</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="waktutempuhsekolah" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Anak Ke</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="anakke" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Jumlah Saudara Kandung</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="jumlahsaudarakandung" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
          </tbody>
        </table>
      </div>
    </div>
  </div>
  <div class="panel panel-info" id="3">
    <header class="panel-heading"> Data Orang Tua </header>
    <div class="panel-body">
      <div class="col-sm-6">
        <table class="table table-responsive" width="100%">
          <tbody>
            <tr>
              <th colspan="3">Data Ayah </th>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Nama Ayah</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="ayah_nama" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^a-zA-Z ]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Tahun Lahir Ayah</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="ayah_tahunlahir" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" maxlength="4" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Pendidikan Ayah</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <select required="" class="form-control selectoption valselect" name="ayah_pendidikan" id="ayah_pendidikan" value="">
                  <option value="">Silahkan Pilih</option>
                  <option value="TIDAK SEKOLAH">TIDAK SEKOLAH</option>
                  <option value="TK">TK</option>
                  <option value="SD">SD</option>
                  <option value="SMP">SMP</option>
                  <option value="SMA">SMA</option>
                  <option value="D1">D1</option>
                  <option value="D2">D2</option>
                  <option value="D3">D3</option>
                  <option value="S1">S1</option>
                  <option value="S2">S2</option>
                  <option value="S3">S3</option>
                </select>
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Pekerjaan Ayah</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="ayah_pekerjaan" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Penghasilan Ayah</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="ayah_penghasilan" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Kebutuhan Khusus Ayah</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="ayah_kebutuhankhusus" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <th colspan="3">Data Ibu </th>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Nama Ibu</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="ibu_nama" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^a-zA-Z ]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Tahun Lahir Ibu</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="ibu_tahunlahir" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" maxlength="4" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Pendidikan Ibu</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <select required="" class="form-control selectoption valselect" name="ibu_pendidikan" id="ibu_pendidikan" value="">
                  <option value="">Silahkan Pilih</option>
                  <option value="TIDAK SEKOLAH">TIDAK SEKOLAH</option>
                  <option value="TK">TK</option>
                  <option value="SD">SD</option>
                  <option value="SMP">SMP</option>
                  <option value="SMA">SMA</option>
                  <option value="D1">D1</option>
                  <option value="D2">D2</option>
                  <option value="D3">D3</option>
                  <option value="S1">S1</option>
                  <option value="S2">S2</option>
                  <option value="S3">S3</option>
                </select>
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Pekerjaan Ibu</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="ibu_pekerjaan" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Penghasilan Ibu</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" required="" name="ibu_penghasilan" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Kebutuhan Khusus Ibu</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="ibu_kebutuhankhusus" class="form-control valinput" type="text" value="">
              </td>
            </tr>
          </tbody>
        </table>
      </div>
      <div class="col-sm-6">
        <table class="table table-responsive" width="100%">
          <tbody>
            <tr>
              <th colspan="3">Data Wali </th>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Nama Wali</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="wali_nama" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^a-zA-Z ]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Tahun Lahir Wali</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="wali_tahunlahir" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" maxlength="4" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Pendidikan Wali</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <select class="form-control selectoption valselect" name="wali_pendidikan" id="wali_pendidikan" value="">
                  <option value="">Silahkan Pilih</option>
                  <option value="TIDAK SEKOLAH">TIDAK SEKOLAH</option>
                  <option value="TK">TK</option>
                  <option value="SD">SD</option>
                  <option value="SMP">SMP</option>
                  <option value="SMA">SMA</option>
                  <option value="D1">D1</option>
                  <option value="D2">D2</option>
                  <option value="D3">D3</option>
                  <option value="S1">S1</option>
                  <option value="S2">S2</option>
                  <option value="S3">S3</option>
                </select>
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Pekerjaan Wali</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="wali_pekerjaan" class="form-control valinput" type="text" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Penghasilan Wali</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="wali_penghasilan" class="form-control valinput" type="text" onkeyup="this.value=this.value.replace(/[^0-9]/g,'')" value="">
              </td>
            </tr>
            <tr>
              <td style="vertical-align: middle" width="30%">Kebutuhan Khusus Wali</td>
              <td style="vertical-align: middle" width="1%">:</td>
              <td style="vertical-align: middle" width="69%">
                <input autocomplete="off" name="wali_kebutuhankhusus" class="form-control valinput" type="text" value="">
              </td>
            </tr>
          </tbody>
        </table>
      </div>
      <div class="col-sm-6 pull-right">
        <img src="https://www.ppdb.smansakuba.sch.id/captcha/1718959883.6176.jpg" style="width: 200; height: 40; border: 0;" alt=" "> <input id="captcha" required="" autocomplete="off" placeholder="Ketikkan Captcha" type="text"
          class="form-control valinput" name="yourcaptcha" style="width:200px; margin-top:10px;">
        <br>
        <button class="btn btn-primary btn-parsley" type="submit" style="padding: 10px; margin: 0; width: 100%;">KIRIM PENDAFTARAN</button>
        <br><br>
      </div>
    </div>
  </div>
</form>

Text Content

PPDB 2024 SMA NEGERI 1 KUPANG BARAT
 * Pendaftaran
 * Informasi
 * Cetak Bukti Pendaftaran
 * Cek Kelulusan


FORMULIR PENDAFTARAN

 1. Home
 2. Formulir Pendaftaran

Data Calon Peserta Didik

Nama Lengkap : Jenis Kelamin : Silahkan Pilih LAKI-LAKI PEREMPUAN NISN : NIK :
Tempat Lahir : Tanggal Lahir : Agama : Silahkan Pilih ISLAM KRISTEN KATOLIK
HINDU BUDHA KONGHUCU KEPERCAYAAN KEPADA TUHAN YME Telepon : No HP : Email :
SKHUN : Penerima KPS : Silahkan Pilih YA TIDAK No KPS : Berat Badan (KG) :
Tinggi Badan (CM) : Kebutuhan Khusus :

Alamat : RT : RW : Dusun : Kelurahan/Desa : Kecamatan : Kabupaten/Kota :
Provinsi : Kode Pos : Jenis Tinggal : Silahkan Pilih BERSAMA ORANGTUA BERSAMA
WALI Alat Transportasi : Jarak Rumah ke Sekolah : Waktu Tempuh ke Sekolah : Anak
Ke : Jumlah Saudara Kandung :

Data Orang Tua

Data Ayah Nama Ayah : Tahun Lahir Ayah : Pendidikan Ayah : Silahkan Pilih TIDAK
SEKOLAH TK SD SMP SMA D1 D2 D3 S1 S2 S3 Pekerjaan Ayah : Penghasilan Ayah :
Kebutuhan Khusus Ayah : Data Ibu Nama Ibu : Tahun Lahir Ibu : Pendidikan Ibu :
Silahkan Pilih TIDAK SEKOLAH TK SD SMP SMA D1 D2 D3 S1 S2 S3 Pekerjaan Ibu :
Penghasilan Ibu : Kebutuhan Khusus Ibu :

Data Wali Nama Wali : Tahun Lahir Wali : Pendidikan Wali : Silahkan Pilih TIDAK
SEKOLAH TK SD SMP SMA D1 D2 D3 S1 S2 S3 Pekerjaan Wali : Penghasilan Wali :
Kebutuhan Khusus Wali :


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