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Proposal

Membangun Rumah Tangga


Sakinah Mawadah Rohmah Wa Da’wah

Oleh :

Nama : ____________________________
BIODATA PRIBADI

A. DATA PRIBADI

1. Nama lengkap : _____________________________________________________


2. Nama panggilan : _________________________________( Laki-laki / Perempuan )
3. Tempat, tgl lahir : _____________________________________________________
4. Alamat Malang : _____________________________________________________
: _____________________________________________________
Telepon : ________________________ Kode Pos : ___________
5. Handphone : __________________________ dan _______________________
6. Email : ___________________________ website : __________________
7. Alamat asal : _____________________________________________________
_____________________________________________________
Telepon : ________________________ Kode Pos : ___________
8. Pekerjaan : _____________________________________________________
9. Alamat kantor : _____________________________________________________
_____________________________________________________
Telepon : ________________________ Kode Pos : ___________
10. Anak ke : __________ dari : _________ saudara.
11. Suku bangsa : _______________________________ _____________________
12. Status marital : Belum menikah / menikah / janda / duda ( lingkari salah satu )
13. Berat badan : ______ Kg. Tinggi badan : _____ Cm. Golongan darah : _______
14. Ciri khusus fisik : _____________________________________________________
15. Hobby : _____________________________________________________
_____________________________________________________
16. Penyakit yang pernah diderita : ___________________________________________
17. Sifat yang dimiliki :
a) Positif : _________________________________________________________
_________________________________________________________
b) Negatif : _________________________________________________________
_________________________________________________________
18. Penghasilan perbulan : ___________________________________________________
B. RIWAYAT PENDIDIKAN FORMAL

Nama lembaga pendidikan Tempat Pelaksanaan (thn)


Jenjang
( jurusan, institusi) (kota) Mulai Selesai
SD
SMP
SMA
DIPLOMA
SARJANA
MASTER
DOKTOR

C. DATA ORANG TUA

1. Nama BAPAK : _____________________________________________________


2. Tempat, tgl lahir : _____________________________________________________
3. Pendidikan : _____________________________________________________
4. Pekerjaan : _____________________________________________________
5. Alamat : _____________________________________________________
_____________________________________________________
Telepon : ________________________ Kode Pos : ___________
6. Kondisi Keislaman : _____________________________________________________
(jelaskan secara _____________________________________________________
rinci ) _____________________________________________________

1. Nama IBU : _____________________________________________________


2. Tempat, tgl lahir : _____________________________________________________
3. Pendidikan : _____________________________________________________
4. Pekerjaan : _____________________________________________________
5. Alamat : _____________________________________________________
_____________________________________________________
Telepon : ________________________ Kode Pos : ___________
6. Kondisi Keislaman : _____________________________________________________
(jelaskan secara _____________________________________________________
rinci ) _____________________________________________________
D. DATA SAUDARA KANDUNG ( bila tidak cukup, tulis di belakang kertas ini )

Nama saudara Tempat,


No Status Pendidikan Pekerjaan Kondisi Keislaman
kandung tanggal lahir
1.
2.
3.
4.
5.
6.

E. RIWAYAT PENDIDIKAN NON FORMAL (training, pelatihan dsb)


Pelaksanaan
No Nama Pelatihan / dauroh / training Lembaga
Tahun Lama
1.
2.
3.
4.
5.
6.
7.
8.
9.

F. RIWAYAT PEKERJAAN (sebagai Karyawan maupun Wiraswasta)

Pelaksanaan (bln / thn)


No Nama Pekerjaan / Perusahaan + Bidang Jabatan
Mulai Selesai
1.
2.
3.

G. PENGALAMAN ORGANISASI /PANITIA (keislaman, profesi/mahasiswa dsb)

Pelaksanaan (tahun)
No Nama Organisasi / Kepanitiaan Jabatan
Mulai Selesai
1.
2.
3.
4.
5.
H. JABARKAN SECARA DETAIL, PERTANYAAN BERIKUT INI.
a) Kepribadian diri (watak, karakter diri, kelebihan dan kekurangan, hal yang disukai,
hal yang tidak disukai, dan sebagainya)
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b) Kondisi keluarga (latar belakang, pendidikan keluarga, tingkat pemahaman terhadap
Islam dan dakwah, kultur, tingkat ekonomi dan sebagainya)
______________________________________________________________________
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c) Rencana ke depan (sumber ekonomi, jumlah hutang dan jumlah piutang, rencana
karier/pekerjaan dan dakwah dsb)
______________________________________________________________________
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d) Ibadah harian (sholat berjamaah, tilawah alquran dan hapalan, qiyamullail dsb)
______________________________________________________________________
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e) Konsep pernikahan menurut anda? Gambaran rumah tangga yang akan dibagun ?
______________________________________________________________________
______________________________________________________________________
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f) Usaha apa yang sudah dan sedang anda lakukan berkaitan dengan pernikahan ini.
(misal, baca buku pernikahan, pengkondisian orang tua dsb)
______________________________________________________________________
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g) Kriteria pendamping hidup yang anda harapkan


______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

h). Siapakah saja yang telah memberi izin dan merestui anda untuk menikah ?
a. Bapak (ya/tidak/dgn catatan) : ___________________________________________
b. Ibu (ya/tidak/dgn catatan) : ______________________________________________
c. lainnya : _____________________________________________________________

Data ini saya buat dengan sebenarnya, untuk kepentingan proses pernikahan semata. Dan
mohon dijaga kerahasiaannya terhadap pihak-pihak yang tidak berkepentingan. Semoga
Allah memudahkan dan menolong hambaNya yang akan mengikuti sunnah rosulNya.

Malang, ________________________

( ________________________________ )

Keterangan
1. Data ini akan diperbaharui, tiap 3 bulan sekali.
2. Mohon dilengkapi foto postcard dan pas foto 4x6 serta foto keluarga (bila ada)
Lampiran Foto Diri
( Ketika sendirian/poscard, ketika bersama keluarga atau ketika sedang dalam
suatu aktifitas )

Foto - 1 Foto - 2

Foto - 3