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

:

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No. Peserta


:

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NUPTK

:

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NIP.

:

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Tempat dan Tanggal Lahir

:


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Jenis Kelamin

:

L/P

Agama

:

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Alamat Tempat Tinggal

:

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No. Telp. Rumah/Keluarga

:

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No. HP.

:

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Sekolah Tempat Bertugas

:

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Alamat Sekolah


:

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No. Telp. Sekolah

:

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Ijazah S1 (Prodi)

:

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Nama Perguruan Tinggi


:

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Lama Mengajar

:

…….. Tahun ……. Bulan
.................., .......................... 2016

4x6 3)

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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.