BIODATA PESERTA PLPG TAHUN 2016
NO. DOK : ..........
KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI
UNIVERSITAS NEGERI YOGYAKARTA
LEMBAGA PENGEMBANGAN DAN PENJAMINAN MUTU PENDIDIKAN
Panitia Sertifikasi Guru Rayon 111
P4TKN, Gedung LPPMP Lantai 3 Sayap Timur, Kampus Karangmalang Yogyakarta 55281
Telepon/Fax (0274) 550852 pesawat 144; Laman : sertifikasiguru.uny.ac.id; E-mail : sertifikasiguru_uny@yahoo.com
BIODATA PESERTA1)
KELAS : ............. 2)
Nama Lengkap dan Gelar
:
............................................................................................
No. Peserta
:
............................................................................................
NUPTK
:
............................................................................................
NIP.
:
............................................................................................
Tempat dan Tanggal Lahir
:
............................................................................................
Jenis Kelamin
:
L/P
Agama
:
............................................................................................
Alamat Tempat Tinggal
:
............................................................................................
............................................................................................
No. Telp. Rumah/Keluarga
:
........................................................................................... .
No. HP.
:
............................................................................................
Sekolah Tempat Bertugas
:
...........................................................................................
Alamat Sekolah
:
..........................................................................................
..........................................................................................
No. Telp. Sekolah
:
...........................................................................................
Ijazah S1 (Prodi)
:
..........................................................................................
Nama Perguruan Tinggi
:
..........................................................................................
Lama Mengajar
:
…….. Tahun ……. Bulan
.................., .......................... 2016
4x6 3)
.....................................................
No. Peserta .................................
Keterangan:
1)
2)
3)
Diketik komputer/tulis tangan.
Disesuaikan dengan nama kelas pemanggilan PLPG.
Pas foto ukuran 4x6 cm ditempel, ukuran 3x4 (3 lembar) diklip.
KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI
UNIVERSITAS NEGERI YOGYAKARTA
LEMBAGA PENGEMBANGAN DAN PENJAMINAN MUTU PENDIDIKAN
Panitia Sertifikasi Guru Rayon 111
P4TKN, Gedung LPPMP Lantai 3 Sayap Timur, Kampus Karangmalang Yogyakarta 55281
Telepon/Fax (0274) 550852 pesawat 144; Laman : sertifikasiguru.uny.ac.id; E-mail : sertifikasiguru_uny@yahoo.com
BIODATA PESERTA1)
KELAS : ............. 2)
Nama Lengkap dan Gelar
:
............................................................................................
No. Peserta
:
............................................................................................
NUPTK
:
............................................................................................
NIP.
:
............................................................................................
Tempat dan Tanggal Lahir
:
............................................................................................
Jenis Kelamin
:
L/P
Agama
:
............................................................................................
Alamat Tempat Tinggal
:
............................................................................................
............................................................................................
No. Telp. Rumah/Keluarga
:
........................................................................................... .
No. HP.
:
............................................................................................
Sekolah Tempat Bertugas
:
...........................................................................................
Alamat Sekolah
:
..........................................................................................
..........................................................................................
No. Telp. Sekolah
:
...........................................................................................
Ijazah S1 (Prodi)
:
..........................................................................................
Nama Perguruan Tinggi
:
..........................................................................................
Lama Mengajar
:
…….. Tahun ……. Bulan
.................., .......................... 2016
4x6 3)
.....................................................
No. Peserta .................................
Keterangan:
1)
2)
3)
Diketik komputer/tulis tangan.
Disesuaikan dengan nama kelas pemanggilan PLPG.
Pas foto ukuran 4x6 cm ditempel, ukuran 3x4 (3 lembar) diklip.