LAPORAN

PENILAIAN HASIL BELAJAR SANTRI

PROGRAM DINIYAH TAKMILIYAH ULYA

PONDOK PESANTREN SALAFIYAH
TINGKAT ULYA

Nama Santri :
No. Induk :
NSPP : 512150502013
PPS : Al – Musthofa Tsani

KEMENTERIAN AGAMA RI
KANTOR WILAYAH KEMENTERIAN AGAMA
PROVINSI JAMBI
 1

PETUNJUK PENGGUNAAN DAN PENGISIAN

1. Buku Laporan Penilaian Hasil Belajar ini, dipergunakan selama santri mengikuti Program
Catatan dari Penanggung Jawab Program
Diniyah Taklimiyah Ulya.
2. Apabila Santri Pindah PPS ke PPS lain, maka Buku Laporan Penilaian Hasil Belajar ini dibawa
oleh santri yang bersangkutan untuk dapat dipergunakan di PPS yang baru
Semester I
3. Apabila Buku Laporan Penilaian Hasil Belajar santri yang bersangkutan hilang, dapat diganti
dengan Buku Laporan Penilaian Hasil Belajar pengganti yang nilainya diambil dari Buku Induk
PPS asal santri dan disahkan oleh Kepala PPS asal.
4. Buku Laporan Penilaian Hasil ini terdiri dari atas : halaman pentunjuk penggunaan/pengisian,
halaman identitas santri, halaman lembaran nilai, halaman tentang kegiatan, keadaan santri dan
catatan khusus serta halaman penyelesaian program pendidikan
a. Halaman tentang identitas santri didisi dengan data santri secara lengkap disertai pas fhoto
ukuran 3 x 4 cm
b. Halaman tentang nilai diisi dan ditetapkan PPS dan nilai hasil belajar santri yang dilakukan
Mengetahui : Penanggung Jawab Program
oleh Ustadz dan dirangkum dari semua aspek penilaian (Kognitif,Apektif, Psikomotorik) Orang Tua / Wali
baik secara kuantitatif maupun Kualitatif termasuk nilai pengembangan diri
c. Halaman tentang kegiatan,keadaan santri dan catatan Ustadz disi dengan berbagai aktifitas
dan kondisi santri serta komentar atau catatan Ustadz dan Penanggung Jawab tentang
pencapaian kompetensi santri termasuk sikap.
d. Halaman keterangan pindah diisi apabila ada hal-hal yang perlu mendapat perhatian secara
…………………………….. ………………………………..
khusus selama proses pendidikan di PPS.
e. Halaman catatan khusus diisi apabila ada hal-hal yang perlu mendapat perhatian khusus
sealama proses pendidikan di PPS.
f. Halaman penyelesaian program pendidikan diisi apabila santri yang bersangkutan Semester II
selesai/tamat dalam mengikuti program pendidikan di PPS.
5. Rentang nilai yang ditulis dalam buku laporan penilaian ini berkisar antara nol sampai dengan
seratus ( 0 – 100 ).
6. Buku Laporan ini dilengkapi dengan data nilai yang dihimpun oleh Ustadz dan penanggung
jawab dalam bentuk forto polio dari ulangan harian,tengah semester dan semester.
KETERANGAN NILAI DENGAN ANGKA
100 = Istimewa 50 = Hampir Cukup
90 = Baik Sekali 40 = Kurang Mengetahui : Penanggung Jawab Program
80 = Baik 30 = Kurang Sekali
70 = Lebih dari Cukup 20 = Buruk Orang Tua / Wali
60 = Cukup 10 = Buruk Sekali

KETERANGAN NILAI HURUF

A = Baik Sekali B = Baik
C = Cukup D = Kurang …………………………….. ………………………………..
E = Amat Kurang
 30
29
IDENTITAS SANTRI

KETERANGAN MENYELESAIKAN 1. Nomor Induk : .........................................................................

PROGRAM DINIYAH TAKMILIYAH ULYA 2. Nama : .........................................................................
a. Nama Lengkap : .........................................................................
PONDOK PESANTREN SALAFIYAH b. Nama Panggilan : .........................................................................
TINGKAT ULYA 3. Tempat/Tanggal lahir : .........................................................................
4. Jenis Kelamin : Laki-Laki/Perempuan
5. Agama : Islam
6. Alamat :
Berdasarkan hasil ujian Diniyah Taklimiyah Ulya pada PPS. Al-Musthofa Tsani : ...........................Telp/HP................................
Tingkat Ulya Tahun Pelajaran : 7. Diterima di Program ini Tanggal : .........................................................................
8. Pondok Pesantren
a. Nama Pesantren : Al-Musthofa Tsani
Nama : b. Tahun dan Nomor Ijazah : .........................................................................
c. Alamat : ...........................Telp/HP................................
Nomor Induk : 9. Orang Tua : .........................................................................
a. Nama Ayah : .........................................................................
Dinyatakan telah menyelesaikan Program Pendidikan Pada PPS.Al-Musthofa Tsani - Pendidikan : .........................................................................
- Pekerjaan : .........................................................................
Tingkat ULYA ........................................................................................................... - Alamat : .........................................................................
: ...........................Telp/HP................................
Dengan Ijazah Nomor : .............................................................................................. b. Nama Ibu : .........................................................................
- Pendidikan : .........................................................................
- Pekerjaan : .........................................................................
- Alamat : .........................................................................
: ...........................Telp/HP................................
10. Wali :
Rantau Badak, .................................... Nama Wali : .........................................................................
- Pendidikan : .........................................................................
Penanggung Jawab Program - Pekerjaan : .........................................................................
- Alamat : .........................................................................
: ...........................Telp/HP................................

Rantau Badak, ..............................20...

Penanggung Jawab Program
............................................................. Pas Fhoto
3x4

...................................................
 3
2 KETERANGAN PINDAH PONDOK PESANTREN
RAPORT DINIYAH TAKLIMIYAH ULYA NAMA SANTRI : ............................................

Nama Santri : .................................................. Kelas : ........................ Diisi oleh Pondok Pesantren yang ditinggalkan (Pondok Pesantren Asal)
Nomor Induk : .................................................. Semester : ........................
Nama PPS : Al-Musthofa Tsani Tahun Pelajaran : ........................ KELUAR
Tanda tangan penanggung jawab Program
Kelas yang
NILAI Tanggal Sebab-sebab keluar Stempel PPS dan
ditinggalkan
Tanda tangan Orangtua/Wali
No. MATA PELAJARAN Hasil Belajar Santri Nilai Rata - rata
Angka Huruf Angka Huruf ............................................20...
I. Pendidikan Salafiyah Penanggung Jawab Program
1 Nahwu
2 Syorof ................................................
3 Fiqih Salaf
Orang Tua/Wali
4 Tafsir
5 Mustholah Hadits
( .............................................. )
6 Hadits
7 Ushul Fiqh ............................................20...
8 Faraidh Penanggung Jawab Program
9 Tasawuf
10 Muhthasar ................................................
11
Orang Tua/Wali
12
13
( .............................................. )
Jumlah Nilai
Rata-rata ............................................20...
Penanggung Jawab Program
Peringkat Kelas Ke ............. dari ....................... Santri

PENGEMBANGAN SANTRI ................................................

NILAI
No. BENTUK KEGIATAN Orang Tua/Wali
A B C
1.
2. ( .............................................. )
3.
28
 KETERANGAN PINDAH PONDOK PESANTREN KEGIATAN PEMBIASAAN
NAMA SANTRI :............................................... ................................................................................................................................................
................................................................................................................................................
Diisi oleh Pondok Pesantren yang menerima (Pondok Pesantren yang baru) ................................................................................................................................................
No. MASUK
................................................................................................................................................
................................................................................................................................................
1. Nama Santri .......................................
.........................................20....
2. Nomor Induk .......................................
PERILAKU/KEPRIBADIAN KETIDAKHADIRAN/ABSENSI
3. Nama PPS ....................................... Penanggung Jawab Program No Aspek Keterangan No Alasan Jumlah Hari
1. Kelakuan 1. Sakit
4. Masuk di PPS ini .......................................
2. Kerajinan 2. Izin
a. Tanggal ....................................... 3. Kebersihan & Kerapian 3. Tanpa Keterangan
b. Dikelas .......................................
5. Tahun Pelajaran ....................................... CATATAN :
...............................................
1. ...........................................................................................................................................
1. Nama Santri ....................................... 2. ..........................................................................................................................................
.........................................20.... 3. ..........................................................................................................................................
2. Nomor Induk .......................................
4. ..........................................................................................................................................
3. Nama PPS ....................................... Penanggung Jawab Program 5. ..........................................................................................................................................
4. Masuk di PPS ini ....................................... 6. ..........................................................................................................................................
7. ..........................................................................................................................................
a. Tanggal ....................................... 8. ..........................................................................................................................................
b. Dikelas ....................................... 9. ..........................................................................................................................................
10. ..........................................................................................................................................
5. Tahun Pelajaran ....................................... ............................................... a. ................................................................................................................................
b. ................................................................................................................................
1. Nama Santri c. ................................................................................................................................
2. Nomor Induk .........................................20....
Ditetapkan di : ..............................................
3. Nama PPS Penanggung Jawab Program Pada Tanggal : ..............................................
4. Masuk di PPS ini
a. Tanggal Mengetahui : Penanggung Jawab Program
Orang Tua/Wali
b. Dikelas
5. Tahun Pelajaran
...............................................

........................................................... ...........................................................
27
4
RAPORT DINIYAH TAKLIMIYAH ULYA
Nama Santri : .................................................. Kelas : .................... KEGIATAN PEMBIASAAN
Nomor Induk : .................................................. Semester : .................... ................................................................................................................................................
Nama PPS : Al-Musthofa Tsani Tahun Pelajaran : .................... ................................................................................................................................................
................................................................................................................................................
NILAI ................................................................................................................................................
No MATA PELAJARAN Hasil Belajar Santri Nilai Rata - rata ................................................................................................................................................
Angka Huruf Angka Huruf
I. Pendidikan Salafiyah
PERILAKU/KEPRIBADIAN KETIDAKHADIRAN/ABSENSI
1 Nahwu No. Aspek Keterangan No Alasan Jumlah Hari
1. Kelakuan 1. Sakit
2 Syorof
2. Kerajinan 2. Izin
3 Fiqih Salaf 3. Kebersihan & Kerapian 3. Tanpa Keterangan
4 Tafsir
5 Mustholah Hadits CATATAN :
6 Hadits ...............................................................................................................................................
...............................................................................................................................................
7 Ushul Fiqh
...............................................................................................................................................
8 Faraidh ...............................................................................................................................................
9 Tasawuf ...............................................................................................................................................
10 Muhthasar
11
12 Keputusan : ......................................................
Dengan memperhatikan hasil yang dicapai
13 Maka santri ini ditetapkan :
Jumlah Nilai Naik ke kelas .....................(............................)
Tinggal di kelas .................(............................)
Rata-rata
Peringkat Kelas Ke ............. dari ....................... Santri

PENGEMBANGAN SANTRI Mengetahui : Ustadz Pembimbing Penanggung Jawab Program

Orang Tua/Wali
NILAI
No. BENTUK KEGIATAN
A B C
1.
2.
3. ............................... ......................................... .........................................
26
5
RAPORT DINIYAH TAKLIMIYAH ULYA
Nama Santri : .................................................. Kelas : .................... KEGIATAN PEMBIASAAN
Nomor Induk : .................................................. Semester : .................... ................................................................................................................................................
Nama PPS : Al-Musthofa Tsani Tahun Pelajaran : .................... ................................................................................................................................................
................................................................................................................................................
NILAI ................................................................................................................................................
No. MATA PELAJARAN Hasil Belajar Santri Nilai Rata - rata ................................................................................................................................................
Angka Huruf Angka Huruf
I. Pendidikan Salafiyah
PERILAKU/KEPRIBADIAN KETIDAKHADIRAN/ABSENSI
1 Nahwu No. Aspek Keterangan No Alasan Jumlah Hari
1. Kelakuan 1. Sakit
2 Syorof
2. Kerajinan 2. Izin
3 Fiqih Salaf 3. Kebersihan & Kerapian 3. Tanpa Keterangan
4 Tafsir
5 Mustholah Hadits CATATAN :
6 Hadits ...............................................................................................................................................
...............................................................................................................................................
7 Ushul Fiqh
...............................................................................................................................................
8 Faraidh ...............................................................................................................................................
9 Tasawuf ...............................................................................................................................................
10 Muhthasar
11
12 Keputusan : ......................................................
Dengan memperhatikan hasil yang dicapai
13 Maka santri ini ditetapkan :
Jumlah Nilai Naik ke kelas .....................(............................)
Tinggal di kelas .................(............................)
Rata-rata
Peringkat Kelas Ke ............. dari ....................... Santri

PENGEMBANGAN SANTRI Mengetahui : Ustadz Pembimbing Penanggung Jawab Program

Orang Tua/Wali
NILAI
No. BENTUK KEGIATAN
A B C
1.
2.
3. ............................... ......................................... .........................................
6
25
RAPORT DINIYAH TAKLIMIYAH ULYA
Nama Santri : .................................................. Kelas : .................... ................................................................................................................................................
Nomor Induk : .................................................. Semester : .................... ................................................................................................................................................
Nama PPS : Al-Musthofa Tsani Tahun Pelajaran : .................... ................................................................................................................................................
................................................................................................................................................
NILAI ................................................................................................................................................
No. MATA PELAJARAN Hasil Belajar Santri Nilai Rata - rata
Angka Huruf Angka Huruf
I. Pendidikan Salafiyah PERILAKU/KEPRIBADIAN KETIDAKHADIRAN/ABSENSI
No Aspek Keterangan No Alasan Jumlah Hari
1 Nahwu 1. Kelakuan 1. Sakit
2 Syorof 2. Kerajinan 2. Izin
3. Kebersihan & Kerapian 3. Tanpa Keterangan
3 Fiqih Salaf
4 Tafsir
CATATAN :
5 Mustholah Hadits
1. ...........................................................................................................................................
6 Hadits 2. ..........................................................................................................................................
7 Ushul Fiqh 3. ..........................................................................................................................................
4. ..........................................................................................................................................
8 Faraidh 5. ..........................................................................................................................................
9 Tasawuf 6. ..........................................................................................................................................
10 Muhthasar 7. ..........................................................................................................................................
8. ..........................................................................................................................................
11 9. ..........................................................................................................................................
12 10. ..........................................................................................................................................
a. ................................................................................................................................
13 b. ................................................................................................................................
Jumlah Nilai c. ................................................................................................................................
Rata-rata
Ditetapkan di : ..............................................
Peringkat Kelas Ke ............. dari ....................... Santri Pada Tanggal : ..............................................

PENGEMBANGAN SANTRI Mengetahui : Penanggung Jawab Program

Orang Tua/Wali
NILAI
No. BENTUK KEGIATAN
A B C
1.
2.
3. ........................................................... ...........................................................
7
24
RAPORT DINIYAH TAKLIMIYAH ULYA
KEGIATAN PEMBIASAAN
Nama Santri : .................................................. Kelas : .................... KEGIATAN PEMBIASAAN
Nomor Induk : .................................................. Semester : .................... ................................................................................................................................................
Nama PPS : Al-Musthofa Tsani Tahun Pelajaran : .................... ................................................................................................................................................
................................................................................................................................................
NILAI ................................................................................................................................................
No MATA PELAJARAN Hasil Belajar Santri Nilai Rata - rata ................................................................................................................................................
Angka Huruf Angka Huruf
I. Pendidikan Salafiyah
PERILAKU/KEPRIBADIAN KETIDAKHADIRAN/ABSENSI
1 Nahwu No Aspek Keterangan No Alasan Jumlah Hari
2 Syorof 1. Kelakuan 1. Sakit
2. Kerajinan 2. Izin
3 Fiqih Salaf 3. Kebersihan & Kerapian 3. Tanpa Keterangan
4 Tafsir
5 Mustholah Hadits CATATAN :
6 Hadits 1. ...........................................................................................................................................
7 Ushul Fiqh 2. ..........................................................................................................................................
3. ..........................................................................................................................................
8 Faraidh 4. ..........................................................................................................................................
9 Tasawuf 5. ..........................................................................................................................................
10 Muhthasar 6. ..........................................................................................................................................
7. ..........................................................................................................................................
11 8. ..........................................................................................................................................
12 9. ..........................................................................................................................................
10. ..........................................................................................................................................
13 a. ................................................................................................................................
Jumlah Nilai b. ................................................................................................................................
Rata-rata c. ................................................................................................................................
Peringkat Kelas Ke ............. dari ....................... Santri Ditetapkan di : ..............................................
Pada Tanggal : ..............................................
PENGEMBANGAN SANTRI
Mengetahui : Penanggung Jawab Program
NILAI Orang Tua/Wali
No. BENTUK KEGIATAN
A B C
1.
2.
3.
23 ........................................................... ...........................................................
8
RAPORT DINIYAH TAKLIMIYAH ULYA
Nama Santri : .................................................. Kelas : .................... KEGIATAN PEMBIASAAN
Nomor Induk : .................................................. Semester : .................... ................................................................................................................................................
Nama PPS : Al-Musthofa Tsani Tahun Pelajaran : .................... ................................................................................................................................................
................................................................................................................................................
NILAI ................................................................................................................................................
No MATA PELAJARAN Hasil Belajar Santri Nilai Rata - rata ................................................................................................................................................
Angka Huruf Angka Huruf
I. Pendidikan Salafiyah
PERILAKU/KEPRIBADIAN KETIDAKHADIRAN/ABSENSI
1 Nahwu No. Aspek Keterangan No Alasan Jumlah Hari
2 Syorof 1. Kelakuan 1. Sakit
2. Kerajinan 2. Izin
3 Fiqih Salaf 3. Kebersihan & Kerapian 3. Tanpa Keterangan
4 Tafsir
5 Mustholah Hadits CATATAN :
6 Hadits ...............................................................................................................................................
7 Ushul Fiqh ...............................................................................................................................................
...............................................................................................................................................
8 Faraidh ...............................................................................................................................................
9 Tasawuf ...............................................................................................................................................
10 Muhthasar
11
12 Keputusan : ......................................................
Dengan memperhatikan hasil yang dicapai
13
Maka santri ini ditetapkan :
Jumlah Nilai Naik ke kelas .....................(............................)
Rata-rata Tinggal di kelas .................(............................)
Peringkat Kelas Ke ............. dari ....................... Santri

PENGEMBANGAN SANTRI Mengetahui : Ustadz Pembimbing Penanggung Jawab Program

Orang Tua/Wali
NILAI
No. BENTUK KEGIATAN
A B C
1.
2.
3. ............................... ......................................... .........................................
9 22
RAPORT DINIYAH TAKLIMIYAH ULYA

Nama Santri : .................................................. Kelas : ....................

Nomor Induk : .................................................. Semester : .................... ................................................................................................................................................
Nama PPS : Al-Musthofa Tsani Tahun Pelajaran : .................... ................................................................................................................................................
................................................................................................................................................
NILAI ................................................................................................................................................
No MATA PELAJARAN Hasil Belajar Santri Nilai Rata - rata
Angka Huruf Angka Huruf
I. Pendidikan Salafiyah PERILAKU/KEPRIBADIAN KETIDAKHADIRAN/ABSENSI
No Aspek Keterangan No Alasan Jumlah Hari
1 Nahwu 1. Kelakuan 1. Sakit
2 Syorof 2. Kerajinan 2. Izin
3. Kebersihan & Kerapian 3. Tanpa Keterangan
3 Fiqih Salaf
4 Tafsir
CATATAN :
5 Mustholah Hadits
1. ...........................................................................................................................................
6 Hadits 2. ..........................................................................................................................................
7 Ushul Fiqh 3. ..........................................................................................................................................
4. ..........................................................................................................................................
8 Faraidh 5. ..........................................................................................................................................
9 Tasawuf 6. ..........................................................................................................................................
10 Muhthasar 7. ..........................................................................................................................................
8. ..........................................................................................................................................
11 9. ..........................................................................................................................................
12 10. ..........................................................................................................................................
a. ................................................................................................................................
13 b. ................................................................................................................................
Jumlah Nilai c. ................................................................................................................................
Rata-rata
Ditetapkan di : ..............................................
Peringkat Kelas Ke ............. dari ....................... Santri Pada Tanggal : ..............................................

PENGEMBANGAN SANTRI Mengetahui : Penanggung Jawab Program

Orang Tua/Wali
NILAI
No. BENTUK KEGIATAN
A B C
1.
2.
3. ........................................................... ...........................................................
11 20
RAPORT DINIYAH TAKLIMIYAH ULYA

KEGIATAN PEMBIASAAN Nama Santri : .................................................. Kelas : ....................

................................................................................................................................................ Nomor Induk : .................................................. Semester : ....................
Nama PPS : Al-Musthofa Tsani Tahun Pelajaran : .................... ................................................................................................................................................
................................................................................................................................................
NILAI ................................................................................................................................................
No MATA PELAJARAN Hasil Belajar Santri Nilai Rata - rata
Angka Huruf Angka Huruf
I. Pendidikan Salafiyah PERILAKU/KEPRIBADIAN KETIDAKHADIRAN/ABSENSI
No Aspek Keterangan No Alasan Jumlah Hari
1 Nahwu 1.. Kelakuan 1.. Sakit
2 Syorof 2. Kerajinan 2. Izin
3. Kebersihan & Kerapian 3. Tanpa Keterangan
3 Fiqih Salaf
4 Tafsir
CATATAN :
5 Mustholah Hadits
...............................................................................................................................................
6 Hadits ...............................................................................................................................................
7 Ushul Fiqh ...............................................................................................................................................
...............................................................................................................................................
8 Faraidh ...............................................................................................................................................
9 Tasawuf
10 Muhthasar
11 Keputusan : ......................................................
12 Dengan memperhatikan hasil yang dicapai
Maka santri ini ditetapkan :
13
Naik ke kelas .....................(............................)
Jumlah Nilai Tinggal di kelas .................(............................)
Rata-rata
Peringkat Kelas Ke ............. dari ....................... Santri
Mengetahui : Ustadz Pembimbing Penanggung Jawab Program
PENGEMBANGAN SANTRI Orang Tua/Wali
NILAI
No. BENTUK KEGIATAN
A B C
1.
2. ............................... ......................................... .........................................
3.
21 10
RAPORT DINIYAH TAKLIMIYAH ULYA

KEGIATAN PEMBIASAAN Nama Santri : .................................................. Kelas : ....................

................................................................................................................................................ Nomor Induk : .................................................. Semester : ....................
................................................................................................................................................ Nama PPS : Al-Musthofa Tsani Tahun Pelajaran : ....................
 ................................................................................................................................................
NILAI ................................................................................................................................................
No MATA PELAJARAN Hasil Belajar Santri Nilai Rata - rata
Angka Huruf Angka Huruf
I. Pendidikan Salafiyah PERILAKU/KEPRIBADIAN KETIDAKHADIRAN/ABSENSI
No Aspek Keterangan No Alasan Jumlah Hari
1 Nahwu 1.. Kelakuan 1.. Sakit
2 Syorof 2. Kerajinan 2. Izin
3. Kebersihan & Kerapian 3. Tanpa Keterangan
3 Fiqih Salaf
4 Tafsir
CATATAN :
5 Mustholah Hadits
...............................................................................................................................................
6 Hadits ...............................................................................................................................................
7 Ushul Fiqh ...............................................................................................................................................
...............................................................................................................................................
8 Faraidh ...............................................................................................................................................
9 Tasawuf
10 Muhthasar
11 Keputusan : ......................................................
12 Dengan memperhatikan hasil yang dicapai
Maka santri ini ditetapkan :
13
Naik ke kelas .....................(............................)
Jumlah Nilai Tinggal di kelas .................(............................)
Rata-rata
Peringkat Kelas Ke ............. dari ....................... Santri
Mengetahui : Ustadz Pembimbing Penanggung Jawab Program
PENGEMBANGAN SANTRI Orang Tua/Wali
NILAI
No. BENTUK KEGIATAN
A B C
1.
2. ............................... ......................................... .........................................
3.
13 18
RAPORT DINIYAH TAKLIMIYAH ULYA

KEGIATAN PEMBIASAAN Nama Santri : .................................................. Kelas : ....................

................................................................................................................................................ Nomor Induk : .................................................. Semester : ....................
................................................................................................................................................ Nama PPS : Al-Musthofa Tsani Tahun Pelajaran : ....................
................................................................................................................................................
 NILAI I. Pendidikan Salafiyah
No MATA PELAJARAN Hasil Belajar Santri Nilai Rata - rata
1 Nahwu
Angka Huruf Angka Huruf
2 Syorof
3 Fiqih Salaf
4 Tafsir
5 Mustholah Hadits
6 Hadits
7 Ushul Fiqh
8 Faraidh
9 Tasawuf
10 Muhthasar
11
12
13
Jumlah Nilai
Rata-rata
Peringkat Kelas Ke ............. dari ....................... Santri

PENGEMBANGAN SANTRI

NILAI
No. BENTUK KEGIATAN
A B C
1.
2.
3.
19
/

KEGIATAN PEMBIASAAN
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
 PERILAKU/KEPRIBADIAN KETIDAKHADIRAN/ABSENSI ...
No Aspek Keterangan No Alasan Jumlah Hari ...
1. Kelakuan 1. Sakit ...
2. Kerajinan 2. Izin ...
3. Kebersihan & Kerapian 3. Tanpa Keterangan ...
...
CATATAN : ...
...
1. ........................................................................................................................................... ...
2. .......................................................................................................................................... ...
3. .......................................................................................................................................... ...
4. .......................................................................................................................................... ...
5. .......................................................................................................................................... ...
6. .......................................................................................................................................... ...
7. .......................................................................................................................................... ...
... .......................................................................................................................................... ...
... ...
... ...
... 8.
... 10. ..........................................................................................................................................
... 9.
... a. ................................................................................................................................
... b. ................................................................................................................................
... c. ................................................................................................................................
...
... Ditetapkan di : ..............................................
... Pada Tanggal : ..............................................
...
... Mengetahui : Penanggung Jawab Program
... Orang Tua/Wali
...
...
...
...
... ........................................................... ...........................................................
... 12
... RAPORT DINIYAH TAKLIMIYAH ULYA
...
...
Nama Santri : .................................................. Kelas : ....................
...
Nomor Induk : .................................................. Semester : ....................
...
Nama PPS : Al-Musthofa Tsani Tahun Pelajaran : ....................
...
...
No MATA PELAJARAN NILAI
 Hasil Belajar Santri Nilai Rata - rata
Angka Huruf Angka Huruf
I. Pendidikan Salafiyah PERILAKU/KEPRIBADIAN KETIDAKHADIRAN/ABSENSI
No Aspek Keterangan No Alasan Jumlah Hari
1 Nahwu 1. Kelakuan 1. Sakit
2 Syorof 2. Kerajinan 2. Izin
3. Kebersihan & Kerapian 3. Tanpa Keterangan
3 Fiqih Salaf
4 Tafsir
CATATAN :
5 Mustholah Hadits
1. ...........................................................................................................................................
6 Hadits 2. ..........................................................................................................................................
7 Ushul Fiqh 3. ..........................................................................................................................................
4. ..........................................................................................................................................
8 Faraidh 5. ..........................................................................................................................................
9 Tasawuf 6. ..........................................................................................................................................
10 Muhthasar 7. ..........................................................................................................................................
8. ..........................................................................................................................................
11 9. ..........................................................................................................................................
12 10. ..........................................................................................................................................
a. ................................................................................................................................
13
b. ................................................................................................................................
Jumlah Nilai c. ................................................................................................................................
Rata-rata
Ditetapkan di : ..............................................
Peringkat Kelas Ke ............. dari ....................... Santri Pada Tanggal : ..............................................

PENGEMBANGAN SANTRI Mengetahui : Penanggung Jawab Program

Orang Tua/Wali
NILAI
No. BENTUK KEGIATAN
A B C
1.
2.
3. ........................................................... ...........................................................
15 16
RAPORT DINIYAH TAKLIMIYAH ULYA
KEGIATAN PEMBIASAAN
................................................................................................................................................ Nama Santri : .................................................. Kelas : ....................
................................................................................................................................................ Nomor Induk : .................................................. Semester : ....................
................................................................................................................................................ Nama PPS : Al-Musthofa Tsani Tahun Pelajaran : ....................
................................................................................................................................................
................................................................................................................................................ No MATA PELAJARAN NILAI
 Hasil Belajar Santri Nilai Rata - rata
Angka Huruf Angka Huruf
I. Pendidikan Salafiyah PERILAKU/KEPRIBADIAN KETIDAKHADIRAN/ABSENSI
No Aspek Keterangan No Alasan Jumlah Hari
1 Nahwu 1.. Kelakuan 1.. Sakit
2 Syorof 2. Kerajinan 2. Izin
3. Kebersihan & Kerapian 3. Tanpa Keterangan
3 Fiqih Salaf
4 Tafsir
CATATAN :
5 Mustholah Hadits
...............................................................................................................................................
6 Hadits ...............................................................................................................................................
7 Ushul Fiqh ...............................................................................................................................................
...............................................................................................................................................
8 Faraidh ...............................................................................................................................................
9 Tasawuf
10 Muhthasar
11 Keputusan : ......................................................
12 Dengan memperhatikan hasil yang dicapai
Maka santri ini ditetapkan :
13
Naik ke kelas .....................(............................)
Jumlah Nilai Tinggal di kelas .................(............................)
Rata-rata
Peringkat Kelas Ke ............. dari ....................... Santri
Mengetahui : Ustadz Pembimbing Penanggung Jawab Program
PENGEMBANGAN SANTRI Orang Tua/Wali
NILAI
No. BENTUK KEGIATAN
A B C
1.
2. ............................... ......................................... .........................................
3.
17 14

KEGIATAN PEMBIASAAN
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................