formulir usulan calon penerima bantuan

FORMULIR USULAN CALON PENERIMA BANTUAN KUALIFIKASI S1 PAUDTAHUN ANGGARAN 2016

Nama : .........................................................................................................

NIP. : ..........................................................................................................

Pangkat/Gol Ruang : ..........................................................................................................

NUPTK : ..........................................................................................................

NPWP : ..........................................................................................................

Tanggal Lahir : ..........................................................................................................

Pendidikan Terakhir : ..........................................................................................................

Jml. Jam Mengajar : ................... X per-Minggu

Masa Kerja : ..........................................................................................................

Status Guru : GTY/GTT/HONDA/Guru Bantu/PNS (Coret yang tidak perlu)

Nama Satuan PAUD : ..........................................................................................................

Status Satuan PAUD : Negeri/Swasta (Coret yang tidak perlu)

Jumlah Rombel/Kelas : ..........................................................................................................

Jml.Murid per-Rombel : ..........................................................................................................

Nama Perguruan Tinggi : ..........................................................................................................

Jumlah Semester : ..........................................................................................................

IPK(Min 2,5) : ..........................................................................................................

Lampiran

1. Fotocopy NUPTK Yang Mengusulkan2. Fotocopy NPWP3. Fotocopy berlegis Ijazah Terakhir4. Fotocopy berlegis SK Pertama s.d Terakhir5. Fotocopy IPK6. Fotocopy Rekening …………………………….