formulir usulan calon penerima bantuan

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FORMULIR USULAN CALON PENERIMA BANTUAN KUALIFIKASI S1 PAUD TAHUN 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 Mengusulkan 2. Fotocopy NPWP 3. Fotocopy berlegis Ijazah Terakhir 4. Fotocopy berlegis SK Pertama s.d Terakhir 5. Fotocopy IPK 6. Fotocopy Rekening …………………………….

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Page 1: 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 …………………………….