PERATURAN KEPALA SEKOLAH .................

NOMOR : ................. TAHUN .................

TENTANG
....................................................................

DENGAN RAHMAT TUHAN YANG MAHA KUASA

KEPALA MADRASAH ..................................
Menimbang : a. Bahwa dalam rangka .................
b. Bahwa berdasarkan pertimbangan sebagaimana dimaksud pada huruf a,
perlu menetapkan Peraturan Kepala Madrasah ................. tentang
..................................;
Mengingat : 1. Undang-undang Republik Indonesia Nomor 20 Tahun 2003 tentang Sistem
Pendidikan Nasional;
2. Peraturan Pemerintah No. 19 Tahun 2005 tentang Standar Nasional
Pendidikan;
3. Peraturan Pemerintah Nomor 17 tahun 2010 tentang Pengelolaan dan
Penyelenggaraan Pendidikan sebagaimana diubah menjadi Peraturan
Pemerintah Nomor 66 tahun 2010 tentang Perubahan atas peraturan
pemerintah Nomor 17 tahun 2010 tentang pengelolaan dan
penyelenggaraan pendidikan;
4. Peraturan Menteri Agama .................
5. Dst .................
Memperhatikan : .....................................................................................
MEMUTUSKAN

Menetapkan : PERATURAN KEPALA MADRASAH ............................ TENTANG ............................

BAB I
KETENTUAN UMUM
Pasal 1
Dalam peraturan ini yang dimaksud dengan:
1. ................. adalah .................
2. Kepala madrasah adalah .................
3. Guru adalah .................
4. Siswa adalah .................
5. Dst
BAB II
..................................
Pasal 2

BAB .................
PENUTUP

1. Dengan berlakunya keputusan ini, maka Keputusan Kepala Madrasah Nomor: .................
Tentang ................. dinyatakan tidak berlaku;
2. Keputusan ini berlaku sejak tanggal ditetapkan.

Ditetapkan di .................
Pada tanggal .................

Kepala madrasah

..................................
NIP.
 KEPUTUSAN KEPALA MADRASAH .................
NOMOR: .................
TENTANG
...................................................

KEPALA MADRASAH ..................................

Menimbang : a. Bahwa .................

b. Bahwa Madrasah .................
c. Berdasarkan pertimbangan sebagaimana dimaksud pada butir a dan b
diatas, perlu menetapkan Keputusan Kepala Madrasah ................. tentang
.................;
Mengingat : 1. Undang-undang Republik Indonesia Nomor 20 Tahun 2003 tentang Sistem
Pendidikan Nasional;
2. Peraturan Pemerintah No. 19 Tahun 2005 tentang Standar Nasional
Pendidikan;
3. Dst .................

Memperhatikan : .....................................................................................
MEMUTUSKAN
MENETAPKAN : KEPUUSAN KEPALA MADRASAH ................. TENTANG .................

KESATU : .....................................................................................
KEDUA : .....................................................................................
KETIGA : .....................................................................................
KEEMPAT : Keputusan ini berlaku sejak tanggal ditetapkan.

Ditetapkan di .................
Pada tanggal .................

Kepala madrasah

..................................
NIP.
 INSTRUKSI KEPALA MADRASAH
NOMOR: ...........................

TENTANG
......................................................

KEPALA MADRASAH ......................................

Dalam rangka .......................................................................................... dengan ini menginstruksikan:

Kepada :
1. ..................................................................................................................................
2. ..................................................................................................................................

Untuk :
KESATU : ..................................................................................................................................
KEDUA : ..................................................................................................................................
KETIGA : dan seterusnya

Instruksi ini mulai berlaku pada tanggal ditetapkan.

Ditetapkan di : ...............................
Pada Tanggal : .

Kepala Madrasah,

NIP. ..
 KOP MADRASAH
---------------------------------------------------------------------------------------------------------

............................................20.....

Kepada
Yth. .....................................................
Di tempat

SURAT EDARAN

NOMOR.................. TAHUN .......................

TENTANG
.....................................................................

Dalam rangka melaksanakan ..................................................., dengan ini kami sampaikan hal-hal

sebagai berikut:

1. ..............................................................................................................
2. ..............................................................................................................
3. ..............................................................................................................
4. Dst

Kepala Madrasah,

NIP. ..
 KOP MADRASAH
------------------------------------------------------------------------------------------------------------

SURAT KETERANGAN
Nomor: ......................................

Yang bertanda tangan di bawah ini:

Nama : ................................................................
NIP : ................................................................
Jabatan : ................................................................

dengan ini menerangkan bahwa:

Nama : ................................................................
NIP : ................................................................
Pangkat/Golongan : ................................................................
Jabatan : ................................................................
Maksud : ................................................................

Demikian Surat Keterangan ini dibuat untuk dipergunakan seperlunya.

..........................................2015
Kepala Madrasah,

.....................................................
NIP..............................................
 SURAT PERINTAH
NOMOR.................................................

Nama (yang memberi perintah) : ......................................................

Jabatan : ......................................................

MEMERINTAHKAN:
Kepada :
Nama : ......................................................
Jabatan : ......................................................
Untuk :
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................

Ditetapkan di : ...............................
Pada Tanggal :
Kepala Madrasah,

......................................................
NIP.
 KOP MADRASAH
--------------------------------------------------------------------------------------------------

SURAT IZIN KEPALA MADRASAH

NOMOR..........................

TENTANG
...................................................................................
Dasar :
a. ...................................................................................
b. ...................................................................................

Kepada :
Nama : .........................................................................................
NIP : .........................................................................................
Jabatan : .........................................................................................
Alamat : .........................................................................................
Untuk : .........................................................................................

Ditetapkan di : ..............................
Pada Tanggal :
Kepala Madrasah,

......................................................
NIP.
 KOP MADRASAH
-----------------------------------------------------------------------------------------------------------

SURAT PERJANJIAN
NOMOR......................................
TENTANG
.............................................................................

Pada hari ini ..........................., tanggal ......................, bulan .............................

tahun ..................., bertempat di ......................, kami yang bertanda tangan d
bawah ini:
1. Nama : ..........................................................
NIP : ..........................................................
Jabatan : ..........................................................
Selanjutnya disebut Pihak Pertama,
2. Nama : ............................................................
NIP : ............................................................
Jabatan : ............................................................
Selanjutnya disebut Pihak Kedua.
Pasal
...............................................................................................................................
...............................................................................................................................
................................................................................................ (isi perjanjian).
Pasal
...............................................................................................................................
...............................................................................................................................
................................................................................................ (isi perjanjian).
Penutup
Surat Perjanjian ini ditandatangani oleh kedua belah pihak pada hari d
tersebut di atas.
Pihak Kedua, Pihak Pertama,

........................................ ........................................
NIP. NIP.

Saksi-saksi:
1. ................................................................. (tanda tangan)
2. ................................................................. (tanda tangan)
 SURAT KUASA
Nomor ..............................

Yang bertanda tangan di bawah ini:

Nama : ............................................................
NIP : ............................................................
Jabatan : ...........................................................

MEMBERI KUASA
Kepada :
Nama : ............................................................
NIP : ............................................................
Jabatan : ...........................................................
Untuk : ......................................................................................................
......................................................................................................
Demikian Surat Kuasa ini dibuat untuk dapat dipergunakan sebagaimana mestinya.

...........................................
Yang diberi kuasa, Yang memberi kuasa,
[Nama Jabatan] Kepala Madrasah,

......................................... ...........................................
NIP. NIP.
 KOP MADRASAH
------------------------------------------------------------------------------------------------------------

Nomor : ................................ 2012

Sifat : ................................
Lampiran : ................................
Hal : Panggilan

Kepada
Yth...............................................
....................................................

Assalamualaikum Wr. Wb.

Dengan ini diminta kedatangan Saudara di Kantor Madrasah ................................ pada:
Hari, Tanggal : .................................................
Waktu : Pukul ...................
Tempat : ....................................................
Menghadap : ....................................................
Kepada : ......................................................
Untuk : ......................................................

Demikian untuk dilaksanakan dan menjadi perhatian sepenuhnya.

Waalaikumussalam Wr. Wb.

Kepala Madrasah,

....
NIP.

Tembusan:
 KOP MADRASAH
------------------------------------------------------------------------------------------------------------

NOTA DINAS
Nomor:...............................
Dari : ..........................................................
Kepada : ..........................................................
Tanggal : ..........................................................
Sifat : ..........................................................
Lampiran : ..........................................................
Hal : ..........................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................
...................................................................................................................................................................

Kepala Madrasah,

....
NIP.
 KOP MADRASAH
-----------------------------------------------------------------------------------------------------------

REKOMENDASI
NOMOR....................................

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

......................................... 2012
Kepala Madrasah,

..........................................
NIP
 KOP MADRASAH
-----------------------------------------------------------------------------------------------------------
......................................... 2012
Kepada
Yth. ...............................................

SURAT PENGANTAR
NOMOR......................................

No Jenis yang dikirim Banyak Keterangan

Diterima tanggal ...............................

Penerima, Kepala Madrasah,

................................................. .................................................
NIP NIP
 BERITA ACARA ..........................
NOMOR.......................

Pada hari ini ............................... tanggal .................... bulan ............ tahun .....................
bertempat di .............................., kami masing-masing:
1. Nama : ..........................................................
NIP : ..........................................................
Jabatan : ..........................................................

Selanjutnya disebut Pihak Pertama,

2. Nama : ............................................................
NIP : ............................................................
Jabatan : ............................................................
Alamat : ............................................................

Selanjutnya disebut Pihak Kedua.

Pasal 1
................................................................................................................................
................................................................................................................................
Pasal 2
................................................................................................................................
................................................................................................................................

Berita Acara ini dibuat dengan sesungguhnya dalam rangkap ............... untuk dipergunakan
sebagaimana mestinya.

Pihak Kedua, Pihak Pertama,

........................................ ........................................
NIP. NIP.

Mengetahui/Mengesahkan,

....................................................
NIP
 KOP MADRASAH
----------------------------------------------------------------------------------------------------------

NOTULEN

Rapat : ...........................................................................................
Hari/Tanggal : ...........................................................................................
Waktu : ...........................................................................................
Agenda Acara : 1. .......................................................................................
2. .......................................................................................
3. dan seterusnya
Pimpinan Rapat : .......................................................................................
Ketua : .......................................................................................
Sekretaris : .......................................................................................
Notulen : .......................................................................................
Peserta Rapat : 1. .......................................................................................
2. .......................................................................................
Hasil Rapat :
1. ........................................................................................................................
2. ........................................................................................................................
3. ........................................................................................................................
4. ........................................................................................................................
5. ........................................................................................................................

Pimpinan Rapat
Ketua,

..........................................
NIP
 KOP MADRASAH
-----------------------------------------------------------------------------------------------------------

DAFTAR HADIR RAPAT

Nama Rapat : .............................................................................................
Hari, Tanggal : .............................................................................................
Waktu : Pukul.............................
Tempat : .............................................................................................
Agenda Acara : .............................................................................................

No Nama Jabatan Tanda tangan Keterangan

Pimpinan Rapat
Ketua,

..........................................
NIP
 KOP MADRASAH
-----------------------------------------------------------------------------------------------------------

SURAT TUGAS
NOMOR.................................................

Kepala Madrasah ............................................ menugaskan kepada:

Nama : ..............................................................................................
NIP : ..............................................................................................
Jabatan : ..............................................................................................
Untuk : ..............................................................................................

Demikian surat tugas ini dibuat untuk dilaksanakan dengan penuh tanggung jawab.

............................................... 2012
Kepala Madrasah,

......................................................
NIP.
Sistematika Laporan Kegiatan Workshop/Pelatihan

Cover
Ringkasan Kegiatan
Pengantar
Daftar Isi
1. Latar Belakang
2. Tujuan
3. Target
4. Waktu dan Tempat Pelaksanaan Kegiatan
5. Peserta
6. Narasumber/Fasilitator/Trainer
7. Metodologi Kegiatan (Workshop/Rapat/Perkemahan/dll)
8. Kronologi dan Hasil Kegiatan
9. Kepanitiaan
10. Jumlah dan Sumber Pendanaan
11. Penutup

Lampiran-lampiran:
Term of Reference (TOR)
Jadwal Kegiatan
Undangan Peserta
Undangan Narasumber
Daftar Hadir Peserta
Daftar Hadir Narasumber/Fasilitator/Trainer
Biodata Narasumber/Fasilitator/Trainer
Rekapitulasi Penggunaan Dana
Daftar Penerimaan Honor/Transport Narasumber
Daftar Penerimaan Honor/Transport Peserta
Kuitansi-kuitansi
Kumpulan Materi
Evaluasi Kegiatan
Foto Kegiatan

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