MAJELIS PENDIDIKAN DASAR DAN MENENGAH

MADRASAH ALIYAH MUHAMMADIYAH (MAM)

ROUDHOTUN NASYI’IN BOARDING SCHOOL JATINOM
NSM : 131233100005
Alamat : Jl. Masjid Besar No. 125 Jatinom Klaten, Kode POS 57481

SURAT TUGAS
Nomor: 178/B.4/MAM.RN/8/2022

Menimbang : Bahwa sehubungan dengan pelaksanaan tugas dan fungsi organisasi di lingkungan
Kementrian Agama, dipandang perlu membuat surat tugas dinas pada Madrasah Aliyah
Muhammadiyah Roudhotun Nasyi’in Boarding School.
Dasar : 1. Undang-undang Nomor 5 Tahun 2014 tentang Aparatur Sipil Negara
2. Peraturan Menteri Agama Nomor 19 Tahun 2019 tentang Organisasi dan Tata
Kerja Instansi Vertikal Kementrian Agama, dan

Memberi Tugas
NO NAMA NIP PANGKAT,GOL JABATAN
1. Adilah Noer Khofifah, S.Pd - - Waka Kesiswaan
2. Nadhifa Qurrota Ainin Irsyadi - - Siswa Kelas XII Putri
3. Fatimah Annuha - - Siswa Kelas XII Putri
4. Keysa Farah Paramesty - - Siswa Kelas XII Putri
5. Zulfikar Hanifah Haristyanti - - Siswa Kelas XII Putri

Untuk : 1. Melaksanakan tugas dan fungsi organisasi di lingkungan Madrasah Aliyah

Muhammadiyah Roudhotun Nasyi’in Boarding School
2. Mengikuti kegiatan Uji Kompetisi KSM Tahun 2022 yang akan dilaksanakan pada :
Hari, Tanggal : Sabtu, 13 Agustus 2022
Pukul : 10.00 WIB s.d selesai
Tempat : MAN 1 Klaten
3. Setelah melaksanakan tugas ini segera melaporkan kepada Kepala Madrasah dan
Staff Tata Usaha untuk diarsip.

Klaten, 11 Agustus 2022

Kepala MA Muhammadiyah
RoudhotunNasyi’inBoarding School

David Perdana, S.Pd.I

NIP : -
 LAMPIRAN LB PERATURAN DIRETUR
JENDERAL PERBENDAHARAAN
NOMOR PER -22
/PB/2013 TENTANG KETENTUAN
LEBIH
LANJUT PELAKSANAAN PERJALANAN
DINAS
NEGERI BAGI PEJABAT NEGARA,
PEGAWAI NEGERI
DAN PEGAWAI TIDAK TETAP.
PEGAWAITIDAKTETA
P.

Pejabat/ Petugas yang mengesahkan

No Pelaksana SPD Hari Tgl
Nama Jabatan Tanda Tangan

1 2 3 4 5 6 7

Adilah Noer
Khofifah, S.Pd
1.
Nadhifa Qurrota
Ainin Irsyadi
2. 13
Fatimah
Annuha Sabtu Agustus
3. 2022
Keysa Farah
4. Paramesty

Zulfikar
5. Hanifah
Haristyanti
 HASIL KEGIATAN
1. Kegiatan : .......................................................................................................

2. Hari/Tanggal : .......................................................................................................

3. Hasil Kegiatan : .......................................................................................................

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Mengetahui,
Kepala Madrasah

David Perdana, S.Pd.I

NIP : -