Pemberkasan Tunjangan Profesi Guru (TPG) RA Madrasah Bulan Januari s.d Juni 2016 ( Segera ) SEKSI PEDIDIKAN MADRASAH 2. Format 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. RA/Madrasah
: .............................................................................
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
: .................................... (untuk pengawas)
23. Alamat Rumah
: .............................................................................
24. Kode POS
: .................................... (wajib diisi)
25. No.HP./Telp. (pribadi)
: .............................................................................
26. Nama Gadis Ibu Kandung
: .............................................................................
Surabaya, 31 Maret 2016
_____________________
*) Data mohon diisi dengan lengkap dan benar;
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. RA/Madrasah
: .............................................................................
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
: .................................... (untuk pengawas)
23. Alamat Rumah
: .............................................................................
24. Kode POS
: .................................... (wajib diisi)
25. No.HP./Telp. (pribadi)
: .............................................................................
26. Nama Gadis Ibu Kandung
: .............................................................................
Surabaya, 31 Maret 2016
_____________________
*) Data mohon diisi dengan lengkap dan benar;