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Jumat, 27 Januari 2012

FORMULIR PENDAFTARAN NO.UNIT TPQ


LEMBAGA PEMBINAAN DAN PENGEMBANGAN TAMAN KANAK-KANAK AL-QUR’AN
BADAN KOMUNIKASI PEMUDA DAN REMAJA MASJID INDONESIA
LPPTKA-BKPRMI KAB. BANYUWANGI
Alamat : Jl. Basuki Rahmat 21 Telp. (0333) 428708, 425700 Banyuwangi
Nomor             :
Lampiran         :
H a l                : Permohonan Nomor Unit

Kepada Yth
Direktur LPPTKA-BKPRMI
Kabupaten Banyuwangi
Di –
            Banyuwangi

            Bismillaahirrohmaanirrohiim
            Assalamu’alaikum Wr. Wb.

            Dalam rangka meningkatkan upaya pengelolaan Pendidikan Al-Qur’an di daerah kami dan setelah melengkapi persyaratan-persyaratan pembukaan TK / TP Al-Qur’an BKPRMI, maka kami mohon kepada Bapak untuk memberikan nomor unit TK / TP Al-Qur’an kami dan selanjutnya membinanya.
            Demikian permohonan ini, atas perhatiannya diucapkan terima kasih. Semoga Allah SWT memberikan kelancaran dakwah kita bersama, AMIN.

Billahittaufiq wal hidayah
Wassalamu’alaikum Wr. Wb.

Banyuwangi, ......................
Pengelola                                                                                       Direktur TK / TP Al-Qur’an


....................................                                                                  .......................................

LEMBAGA PEMBINAAN DAN PENGEMBANGAN TAMAN KANAK-KANAK AL-QUR’AN
BADAN KOMUNIKASI PEMUDA DAN REMAJA MASJID INDONESIA
LPPTKA-BKPRMI KAB. BANYUWANGI
Alamat : Jl. Basuki Rahmat 21 Telp. (0333) 428708, 425700 Banyuwangi


KEADAAN TAMAN PENDIDIKAN AL-QUR’AN
BULAN : ...................................................................

1.      Nama Lembaga Pengelola   : ................................................................................................................
2.      Nama Lembaga                    : ..............................................................................................................
3.      Nomor Unit                          : ..............................................................................................................
4.      Alamat Lengkap                  :
Jalan                                     : ..............................................................................................................
RT / RW                               : ..............................................................................................................
Dusun                                   : ..............................................................................................................
Desa / Kelurahan                  : ..............................................................................................................
Kecamatan                           : ..............................................................................................................
Kabupaten                            : ..............................................................................................................
Nomor Telepon                    : ..............................................................................................................
Nomor HP                            : ..............................................................................................................
5.   Waktu belajar                       : Pagi      : Jam ........................................ s.d ....................................Wib
                                                   : Siang    : Jam ........................................ s.d ...................................Wib
                                                   : Sore      : Jam ........................................ s.d ..................................Wib
                                                   : Malam  : Jam ........................................ s.d .................................. Wib
6.   Jumlah Santri                       :
      a. TK Al-Qur’an                   : Putra ..........................................................................................anak
                                                     Putri ...........................................................................................anak
      b. TP Al-Qur’an                   : Putra ...........................................................................................anak
                                                     Putri ...........................................................................................anak
      c. TQ Al-Qur’an                   : Putra ..........................................................................................anak
                                                     Putri ...........................................................................................anak
      Jumlah Keseluruhan             : .....................................................................................................anak
7.   Nama Kepala Lembaga        : ...........................................................................................
      Jumlah Ustadz                     : Putra ....................................................................................ustadz/dzah
                                                   Putri .....................................................................................ustadz/dzah
      Nama Ustadz / Ustadzah     : .............................................................................................. 
                                                   : ...........................................................................................
                                                   : ............................................................................................
                                                   : .............................................................................................
                                                   : .............................................................................................
                                                   : ..............................................................................................
                                                                                   
Banyuwangi, .........................................................
Direktur TK / TP Al-Qur’an ................................

...........................................................
Lampiran :
SUSUNAN KEPENGURUSAN
1. Ketua Lembaga Pengelola              : ...................................................................................................
2. Direktur TPA / TPQ                       : ..................................................................................................
3. Wakil Direktur TPA / TPQ             : ...................................................................................................
4. Bendahara                                      : .................................................................................................
5. Wakil Bendahara                            : .................................................................................................
6. Kepala Tata Usaha                         : ................................................................................................
7. Wali Kelas Santri                            :   1. ............................................................................................
                                                              2. ...........................................................................................
                                                              3...........................................................................................
  4. .......................................................................................
  5. ...........................................................................................
  6. ..........................................................................................
                                                              7. ...........................................................................................
                                                              8. ......................................................................................
  9. ........................................................................................
  10. ...................................................................................
8. Nama Ustadz dan Ustadzah           :    1. .......................................................................... : ditatar/belum
                                                              2. .......................................................................... : ditatar/belum
                                                              3. .......................................................................... : ditatar/belum
  4. .......................................................................... : ditatar/belum
                                                              5. .......................................................................... : ditatar/belum
                                                              6. .......................................................................... : ditatar/belum
                                                              7. .......................................................................... : ditatar/belum
                                                              8. .......................................................................... : ditatar/belum
  9. .......................................................................... : ditatar/belum
                                                              10. .........................................................................: ditatar/belum
9. Ketua POS (Persatuan Orang Tua Santri)  :1...............................................................................

Banyuwangi, .................................
Pengelola                                                                                 Direktur TK / TP Al-Qur’an


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