Penyaluran Tunjangan Profesi Guru (TPG) Bulan Juli_Desember 2017 (Pengawas Madrasah) Revisi SEKSI PEDIDIKAN MADRASAH Biodata_pengawas

BIODATA PENGAWAS
PENERIMA TUNJANGAN PROFESI GURU
1. Nama lengkap dan gelar

: ...........................................................................

2. NIP.

: ...........................................................................

3. Tempat/Tgl.Lahir

: ...........................................................................

4. Pangkat/Gol.

: ...........................................................................

5. Pengawas

: Dasar / Menengah

6. Kecamatan

: ...........................................................................

7. NUPTK

: ...........................................................................

8. NRG

: ...........................................................................

9. Nomor SK Dirjen

: ...........................................................................

10. Tgl. SK Dirjen Pendis

: ...........................................................................

11. Tahun Lulus Sertifikasi

: ...........................................................................

12. LPTK

: ...........................................................................

13. Jumlah Lembaga

: ...........................................................................

14. Jumlah Guru Binaan

: ...........................................................................

15. Alamat Rumah

: ...........................................................................

16. Kode POS

: .................................... (wajib diisi)

17. No.HP./Telp. (pribadi)

: ...........................................................................

18. Nama Gadis Ibu Kandung

: ...........................................................................
Surabaya,

September 2017

____________________
*) Data mohon diisi dengan lengkap dan benar;