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

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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, ...

__________________ *) Data mohon diisi dengan lengkap dan benar;

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