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1 Pesisir Pantai
2 Dataran Rendah
3 Pegunungan

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1 Daerah Terpencil / Terbelakang
2 Daerah Adat Terpencil
3 Daerah Bencana Alam
4 Daerah Bencana Sosial
5 Daerah Darurat Lainnya
6 Daerah Perbatasan
7 Daerah Transmigrasi
8 Bukan Semuanya

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1 Tidak Ada
2 Maritim & Perikanan
3 Pertanian (Agribisnis)
4 Vokasional
5 Koperasi, UMKM & Ekonomi Syari'ah
6 Peternakan
7 Perkebunan
8 Teknologi
9 Pusat Kesehatan Pesantren
10 Olahraga
11 Seni Budaya
12 Lainnya

ALAMAT MDT SILAKAN DISESUAIKAN (BOLEH DIRUBAH) DENGAN ALAMAT SEBENARNYA LEMBAGA BERADA (ISI S

UNTUK KODE KELURAHAN/DESA, KEC, KAB DAN PROPINSI TIDAK USAH DIISI
MBAGA BERADA (ISI SELENGKAPNYA: KP, RT/RW, DESA)
# KODE NSMDT NAMA MDT

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460 pQvq16aOtkJ0c1GIavfv 311232170461 ASSALAM
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tGYe3+IwI8vIJIirVYUAy
1145 QviKWv+SEk8x7gaVtwe 311232171151 AL - BAROKAH
3HJtetRa5bLXJnzsJNl/nz
Wi

yyov9Xar4E1Qveb2i1Ts
1146 pRLHVLAmlG6pZyqW5x 311232171152 NURUL FATAH
G8atifHmbEOGB09EQiJ
S0RPhKt

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qIwqtNE+ORNMzvMST7
1147 311232171153 ARSYILA
dzZ4Khd/C4YcFEckvhbL
AMxTFUDYe

62QtCaz2s31saNW+/F+
gcY9b/pBtml+yjMrKis+3
1148 ADUOqFtZqrvcm3XUmp 311232171154 JANNATUN NA'IM SURAMANGGALA
b25oOW

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+mCq+fiEDHRlhKzokVR
1149 UgWnhxSgxXXYsl25l3k 311232171155 DARUSSALAM
m+C9Y

XGpX1DrBnoiuLWizR1z
1150 MXHqf2Yt6sC+60wjdUY 311232171156 ROUDOTHUL IRFAN
lc1V9TZ0y1EJ2pBpymbd
8lOL3g

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1151 ndKqHMdU6SFZN7UxsS 311232171157 AL - MUYASAR
12pL8mfnkiEqT3pziHml
ejf53q
 Xq0F7S5HqC/hlpnYyM
mr0KnaQvKCyoqfI9ndID
1152 311232171158 NUR MUHAMMAD
9+xySOunMOaT4ViGZjP
dpS30Sg

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OUJbH21uOY9m62XSk2
1153 311232171159 BAITUL MA'ARIF
5tE6aazeX7QOS8ODvu6
ZIyd2D3

plhItHzNns3jDY7jfpC7A
1154 5rS2bGJB7b/9nj3zNUsz 311232171160 AL - HIKMAH
vvRsxyaZ5ftJSKu/rYLg0/I

A8Aft7DDr80gOy1cBhz
wKTViy8P0sGjvIse2X4tC
1155 311232171161 AL - HUDA
o9pPsk98lAoNt1y3wq0
ShIhn

ElJ4llsIJJqOTM9wobDQ
1156 UjUJ+SxAWOjnaypkKVA 311232171162 BAROKATUT TAQWA
1H3JuQ0uVa4oWU1Hh
D3sI2u2j

I35PzSb3cTGR60MDqSti
1157 YK/DtEVk0RvSR/mmwD 311232171163 DAARUL MUJTABA AL-MUSRI'1
CnoPAiQngoAl+OI04T3
mcBxLWz

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1158 VQfbubO9tWqT+r+LSkU 311232171164 AL - QUR'AN
Zb75Gl3WPYvA+2NK3LL
COhYwPMEq

VrZF1i16L8sOnN44fMfn
curaOEJJzLVwVMwCkCR
1159 311232171165 MIFTAHUSSA'DIYAH
oErjlwQryb9MrDZ0ODQ
VmuJ/b

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Cuz3s9M6lLiK+D5Cog14
1160 ITzCqZTIGw+9gTrSNjkM 311232171166 NURUL JANNAH
jxV+

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thBSQHem1KCFaKW5R
1161 2sULM2amXo27VV6a+2 311232171167 AR - ROHMAN
SfGpDVCQ

pGg04cMowvErnP9SW
1162 HJNp12ox+BR19xC6sfEb 311232171168 NURUL JANNAH
aYzU+3SI6LyGPkTJtpk+Y
Y9r3mi

CXoURwCGYhxYsMxb7l
1163 AM8nNQuJQODuIbJ9H2 311232171169 AL - HIDAYAH RONGGA
11ntCa3SQl87sUeH2SIl
QxLMrhtL
 mN+GBbgadJASeCeZ2Ll
S9ceWiN9ATWsRaDUW
1164 311232171170 AL - MUNIRIYYAH
qCnexfb1JJNQp0W2bX1
agA2JVxdQ

jEO2JsXNLugXkP2U4JZb
HHGH1Zx9t8e4bsYQz/G
1165 311232171171 WASILATUL HUDA
XL/F4FvrCbuMnGFgqyQ
69dYeH

zDm17RVFMEtsNyAk8u
oP//he1fm9K0v/G8fUd
1166 311232171172 AL - HUSNA
hBAwEfou/h3aW3jzVh9
eUnYGK6a

e2sYs9vC36MAds81l0Vr
qBn50QHwp6OLIO22Kt
1167 311232171173 MIFTAHUSSOLIHIN AL-MUSRI 1
mkpL2FMaKy52pc4Tki6j
9W7j+w

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1168 Lk1Off7Auc0u7DEThdb 311232171174 TUNAS UAR
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MtLp

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1169 2E2HqxlSNQEmJ+IeMKo 311232171175 DARUL FALAH NEGLASARI
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OmL6

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1170 /M+tVy6MUixX1bUxbnk 311232171176 PUNCAK SIRNA
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9X8lmgq

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mntP65jbp1S8eTKard39
1171 311232171177 ROUDHATUL FALAH
maZFZYFZZiyNGWV82W
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K0w1W77xAe5nzWloZ1
jaK5Pfj4PipzmWRVi74w
1172 ijj2zktkvtES6S+W+6EJVa 311232171178 ROUDHATUL HUDA AL-MUSRI` II
kG7j

t8fiPwaRHurVB5oYc4s/L
FN8LzNygNBkC0SqXzv7
1173 G0LdCx2+AXykn2UafDv 311232171179 AL - AMANAH
9I3iR

7rrC2Zb0hzu4AX9AFuV
1174 pseME4iV5Eb5xpVKUAK 311232171180 AL - HIDAYAH
1/ck9i/TE+8ZF4vzE1/E9
MneMj

45mQGL99GBGR/0hhog
1175 Gq2j3kYHU1U6YKf2KhA 311232171181 TARBIYATUL AULLAD
JKz5bzB5pjbx0osgqbRD
C6V5UH7
 n4dRAGwQXDKhv/Ggxl
UzP9UF74/Me0HMdfYF
1176 311232171182 NURUL ROHMAN
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3o8JkBdXN

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PzdtxpqaON2nU/WLX8
1177 311232171183 AL - AMANAH
CBnyK0WVUPccRzUPtlX
Em1aC+

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ap1kEFpGbxJEv939m3s
1178 311232171184 JAUHARUL HUDA
8qN3CpPq0G3ozbux04c
CCUQ+1

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2Do+HmDeDiKxStDS+Ky
1179 311232171185 NURUL QUR`AN
WerFl5XYix9xta8d9Ac+t
nDRjC+

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1180 RPm4JjaI47DS99d9llRmi 311232171186 DARUS SALAM BATUJAJAR
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1181 TpTyCKCe9d/Fbc9k1Hy 311232171187 AL - BURHAN
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1182 x0gy3inrvk68hxYiPL0N8 311232171188 DAARUSSA`DIYAH
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AtjUPDyzTOd1bacSgM0
1183 311232171189 AL - HIKMAH
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4QTbq2

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Hlm6CunSF/v9A8lNGE8
1184 EtZ15fw5WOg3LoiaOVB 311232171190 HJ. NURHASANAH
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1185 VD8eXIPcxAa5uhCB2sq 311232171191 GENERASI CENDEKIA
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1186 HAUlvmlLM6Y4ZnRtqTy 311232171192 MIFTAHUL FITRI
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MpWZQzys

cZ0YGXSxqxGi5bje2NEy
1187 VZokFay/wiNr+yNhsm0I 311232171193 DAWATUL FALAH ALFIKRI
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 QpJMnfjlhnMtu7h3gnb
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1188 311232171194 AR - ROHMAN
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W1/iboNTU9HCgg2W4
1189 311232171195 AR - RIYADHAH
OQmValwMlnBI91JVeSc
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dfDsCZ0O7rbhFXz6VrqE
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1190 311232171196 MADINATUL HUDA
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1193 311232171199 ASSA`ADATIL `ABADIYYAH
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1194 311232171200 DARUL HIDAYAH
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5ToHvTVxJfcmFHmO9u
1195 311232171201 AL - KHOLIQ
gpUlfIfjyKwxow7WmMl
KCtnism

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GBPIfgRKHKkBymNS27
1196 HbSe9Ug3pZRDjShfjWB 311232171202 AL - HANAFIAH
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1197 HFzsZb2njLfdLL7i33ig4O 311232171203 AR - ROYYAN
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6evJZAuBXMCKhKYh/nz
1198 311232171204 AR - ROHMAN
QG78Ry9ehNCglfPBTRR
mrZwpc6

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1199 xIsqyNRgQeLv8IJ8y6Dn 311232171205 AN - NUR
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JENIS KELAMIN
KODE KETERANGAN
1 Laki - laki
2 Perempuan

KODE KEWARGANEGARAAN
KODE KETERANGAN
1 WNI
2 WNA

STATUS PEGAWAI:
KODE KETERANGAN
1 PNS
2 Non PNS

JENJANG PENDIDIKAN:
KODE KETERANGAN
0 Tidak Berpendidikan Formal
1 <= SLTP
2 SLTA
3 D1
4 D2
5 D3
6 D4
7 S1
8 S2
9 S3

PENGALAMAN PESANTREN:
KODE KETERANGAN
2 Kurang dari 1 Tahun
3 Antara 1 - 3 Tahun
4 Antara 4 - 5 Tahun
5 Lebih dari 5 Tahun

AGAMA:
KODE KETERANGAN
1 Islam
2 Kristen Protestan
3 Katholik
4 Hindu
5 Budha
 6 Khong Hu Chu

KOMPETENSI YANG DIMILIKI:

KODE KETERANGAN
01 Al Qur'an
02 Tafsir - Ilmu Tafsir
03 Hadits - Ilmu Hadits
04 Tauhid
05 Fiqh - Ushul Fiqh
06 Akhlaq - Tasawuf
07 Tarikh
08 Bahasa Arab
09 Nahwu - Sharaf
10 Balaghah
11 Ilmu Kalam
12 Ilmu Arudh
13 Ilmu Mantiq
14 Ilmu Falak
15 Pendidikan Kewarganegaraan
16 Bahasa Indonesia
17 Matematika
18 Ilmu Pengetahuan Alam
19 Seni Budaya
20 Muatan Lokal
JIKA PNS, DI KOLOM SEBELAHNYA (KOLOM J) NIP WAJIB DIISI
Data Pimpinan MDT (KODE DI KOLOM B TIDAK BOLEH DIRUBAH)

GELAR
# KODE NSMDT NAMA MDT NAMA PIMPINAN GELAR DEPAN
BELAKANG

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cnuV0JGZc30XmWI3L0
1 311232171005 AR-RASYADIAH SAEPUL MUKTADIR
WZS3Igx9jjHgLAaUvfsqx
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94w/0a3mm2CQK/5jBb
2 311232170002 DAARUL AHKAM
8Sas1f4AmABsR+LT5OC
3vml/G

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3 U1NiIc/6PQ3OaUt0cPn 311232170003 AL-MU`AWANAH
AfQOBZuUEr4+qBdPLjd
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8ZctNM4I/CKKsToyUqo
4 311232170004 AR-ROCHMAH
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VX8a1S5

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tEbXR39BjrdWi2tdVPlQ
5 KOiIS2EQi23fDe0XS58vI 311232170005 AL-HUDA
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6 Jc6TtP3O3dDruZ5dg+o5 311232170006 AT TAUBAH
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HSotT
 Mq4Tu4BQ9+gN0g3SB
MwJMnzUGvNIeOisciEU
7 311232170007 MIFTAHUSSALAM
u9diFM+oU4vQQM/tVe
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FmcYMG3fmZq9lKn744
8 311232170008 AL-MUKHLIS
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9 311232170009 AT-TAQWA
A4RzJyTl2i/g3NmB5LPvI
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wRILrj8gor1O2U+74QH
10 Z2Cjwa6/UzTzkJuO6G3j 311232170010 AL-BAROKAH
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11 /1IhONFTsJhDjecIEjlYkF 311232170011 AL-KAUTSAR
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1OGMYDrg51pt2aD3VO
12 6Sc9COQG8wE8J1cpDS 311232170012 RAUDHATUL JANNAH
3NKA6VFqgvNf5kagC3O
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13 bbOMC5ypTRP6KR1saU 311232170013 AL-IKHWAN
vWqWEQjE8Ofo1kAfum
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14 pSPypolKtL38tLf5gD6Vf 311232170014 DAARUL HUDA
q1YRyGczwBFTE53EG0
G0geE8j
 YfWnlgPGyUYI5ypH3EJ2
alHLRRnmkuIP2ce14Z+S
15 311232170015 RIYADUSSURUR
uv/NP0/U3sRjx9A1Tqhh
JM56

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V0bGdtxXo7wtK61abus
16 311232170016 NURUL HUDA
RcnflZWa4or51KlsE7m5
mt3f

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r1uele3SymZw+q5uK9y
17 311232170017 INSAN KAMIL AT-TAQWA
KNzIM5W3elQ+7s405rC
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18 DZhOT4JfSumXz28pEbY 311232170018 MIFTAHUL ILMI
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19 p9zoddIrkNV+Vf5rulDIf 311232170019 AL-IHSAN
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20 O4qgI7UwAOArfARcHa 311232170020 NURUL FALAH
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SD9ytH

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21 wvYh1C5tywi+Eak8J0Ry 311232170021 BAITURROHMAN
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22 1PASaA6zU/fsyYwnPQv 311232170022 AL-FALAH
sMkPZXLERDnGlHS0be6
2TZy+XBG
 tHWvPrvtH5gasT3CXibI
PL4ISZKKYcjuvhGPbG44
23 311232170023 AL-ISKANDARIYYAH
Lum7Y87u4OyE8RlGCm
xlRgr2

492aYSmgOzZ6sZ4HHbll
VPr1JmsZ6SVj36s4fqb6
24 311232170024 AL-BAROKAH
HTFZ253e+
+6Qi0gecp8jLdPD

389s6P59UKa6TU6AEg
WD7vZpmQK6DPtvp3B
25 311232170025 AR-ROHMAN
qDgCqwIZyF0DtGY5uI3L
/FfCQnhja

aQnpZDq7RJkC1s1R8P4
rgNVO5/mbA1bOUBsKL
26 VqwQi8Oh9+pj28jUAPd 311232170026 AL-MUBAROK
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yyBgOpeo8zSRQ7qCzHV
27 BrM9Vo9h8+7mVtN4W 311232170027 AN-NUR
FtpYF+OI

7qv1u3g71njJdXqLNen1
28 DhrzByWb8ZM4SbV5z8 311232170028 AL-HIDAYAH
oR2LVb1Pcswx4A4yPUY
HN2QIRK

vFQ2Gzn/QO14ajC1NUJ
29 J4HDmmADyXIS1Y9/Qt 311232170029 DARUL HUDA
Z8Tw1M2HfWUK8iE+nS
2bo7lfl45

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30 dOIu0RkBXxizGOKDfSO 311232170030 RIYADLUL HUDAA
2QAg+24TzJ0kvgHMu5o
hHl7Ixd
 74WUseyYIfypchMUZ4u
Oi4gG+YLOps3AKwGKFL
31 311232170031 NURUL HUDA
R8gy4cTCiCQNPbjPsX9X
qlHYux

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V3PPnHEm3DIVBm0ghd
32 311232170032 AL-AMANAH
o3G3So0kDRvLXMb6K9
W74qSmb4dY

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3rMwpK8ua0yYxop0Ql5
33 311232170033 AL-FALAH
hw2SCFrnpFvMLYV/aNk
IeRdcWY

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WD1ubOLpGBbreObhY
34 QKMi4lZ6Yt8ZDngZwa2 311232170034 AL-ICHWAN
qzwZ+JDC

firLXHTVm+v+zIPhdvn2f
dVuXnEyy/uDJrUoxz7d9
35 W+2V6ne6HdTJOuyg2F 311232170035 RIYADHUL JANNAH
sKkem

TKDfZZPXcDN0RInHzJ6c
cN0yom7ruYuaYzCftJJt6
36 311232170036 HIDAYATUSSALAM
ziwYmcpUFgIVk0ZT/AG
wkce

zJp2wyHzF4SF3vdRr2Pz
nnJ6KyLrb+3+z4+Itp0Fh
37 311232170037 AL-ISTIQOMAH
Rab2R4Q+OCRReOWgA
9Zxr9W
 PI2Sg1HmNTkysgTIyfEF
ARkf4FYKyOKnQEoWGo
38 311232170038 AL-IBTIDA
C+eNEVMr5h6g/pzMJY
pUO9xOBq

9LGYFWwqZqlwZiG5qYk
XOAhSS9T5f1WpTnxhJ3
39 311232170039 MIFTAHUL JANNAH
IUIxrv6pPtY2vmbBlxdN
W2k5xW

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657LACWCaY79ozIfl0yQ
40 311232170040 AL-IKHLAS
XJhmofmU96AfUyi679j
uGyTL8

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FFj+3SJ35MjA1Nfa91+z
41 mEWRBwQhJqBqbHgki 311232170041 DAARUL MUHSININ
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42 LUFSt81ls31ne9vn3JuSC 311232170042 AS-SA`ADAH
a63M

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43 ykWPc82g8Rb+Q2JMZ+ 311232170043 NURUSY-SYIFA
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44 A67VXhHiTIefYnAxcjhd7 311232170044 AL-MUBAROKAH
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45 p9mBgqX6mfLWEVKcw 311232170045 AT-TAQWA
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NeTk3BphA9
 1dxa/C5KyQSdFol5pTaK
Bm6uDvEmgWsW2qUc
46 311232170046 Darul Fiqri
kPWTf8+GkEaYrWcN5F
DMmCuetzH2

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AIbEWNiyMxah3ICiaj1l0
47 311232170047 ASY-SYIFA
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/
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48 wKIUDJDjDneTQCncdG0 311232170048 AN-NUR
FRV3lI0UfBRpXhaIO+4o
faFgH
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8ZhG4Zu6t8zuR4QRC4
49 wLCWNQx15SscjaTwiU 311232170049 AL-GHUROBA`
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50 YuV8AqJBpjR3kzPAuRM 311232170050 AL-IKHLAS
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1111 z97rAE6a91+c1RmHxG6 311232171117 AL - JIHAD
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1118 d3tYv204cfQy5PTIqYkB 311232171124 AL - HASANAH
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1139 311232171145 AL - HUDA
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1141 hBK9+abS5hw5WFvfzG 311232171147 NURUL WASILAH
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1143 311232171149 AL - MUHAJIRIN
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1149 UgWnhxSgxXXYsl25l3k 311232171155 DARUSSALAM
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1150 MXHqf2Yt6sC+60wjdUY 311232171156 ROUDOTHUL IRFAN
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1151 ndKqHMdU6SFZN7UxsS 311232171157 AL - MUYASAR
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1152 mr0KnaQvKCyoqfI9ndID 311232171158 NUR MUHAMMAD
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1153 311232171159 BAITUL MA'ARIF
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1154 5rS2bGJB7b/9nj3zNUsz 311232171160 AL - HIKMAH
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1155 311232171161 AL - HUDA
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1160 Cuz3s9M6lLiK+D5Cog14 311232171166 NURUL JANNAH
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1162 311232171168 NURUL JANNAH
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1165 XL/F4FvrCbuMnGFgqyQ 311232171171 WASILATUL HUDA
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1065 311232171071 NUR HIDAYAH
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1074 311232171080 AL-IKHLASH CIKAWUNG
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1118 311232171124 AL - HASANAH
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1135 311232171141 DARUNNAJAH
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1139 311232171145 AL - HUDA
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1141 311232171147 NURUL WASILAH
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1142 311232171148 AD - DAWAMAH
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1143 311232171149 AL - MUHAJIRIN
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 NAMA DALAM
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