Anda di halaman 1dari 1

KEMENTERIAN AGAMA KABUPATEN KEBUMEN

LEMBAGA PENDIDIKAN MA’ARIF NU KEBUMEN


MADRASAH IBTIDAIYAH MA’ARIF TRIKARSO
Alamat : Jl. Balai Desa Trikarso No:01 Kec. Sruweng, Kab. Kebumen (54362)
Email : mitrikarso.maarif@gmail.com Website: http://sites.google.com/view/mimaariftrikarso/home

SURAT IZIN KEPALA MADRASAH


NOMOR..........................
TENTANG
...................................................................................

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

MEMBERI IZIN:

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

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

Kepala Madrasah,

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

Anda mungkin juga menyukai