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

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