Pemberkasan Tunjangan Profesi Guru RA Madrasah Bulan Januari - Juni 2014 SEKSI PEDIDIKAN MADRASAH 2. BIODATA

BIODATA
PENERIMA TUNJANGAN PROFESI GURU
1. Nama lengkap dan gelar

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

2. NIP.

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

3. Tempat/Tgl.Lahir

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

4. Pangkat/Gol.

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

5. Mapel/Guru Kelas

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

6. NSM / NSS

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

7. Nama RA/Madrasah

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

8. Alamat RA/Madrasah

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

9. Kecamatan

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

10. No.Telp. Madrasah/Sekolah : .............................................................................
11. Jumlah Rombel

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

12. Jumlah Siswa

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

13. NUPTK

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

14. NRG

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

15. Nomor SK Dirjen

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

16. Tgl. SK Dirjen Pendis

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

17. Tahun Lulus Sertifikasi

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

18. LPTK

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

19. Tugas Utama Mengajar

: ................................... JTM

20. Tugas Tambahan

: ................................... JTM

21. Jumlah JTM (No.19+20)

: ................................... JTM

22. Jumlah Guru Binaan

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

23. Alamat Rumah

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

24. No.Telp. (pribadi)

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

25. Nama Gadis Ibu Kandung

: .............................................................................
Surabaya, ................
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*) Data mohon diisi dengan lengkap dan benar;
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