Orang Tua
Nama Ayah : ..............................................................................................
Tempat / Tgl Lahir : ..............................................................................................
Pekerjaan : ..............................................................................................
Nama Ibu : ..............................................................................................
Tempat / Tgl Lahir : ..............................................................................................
Pekerjaan : ..............................................................................................
Alamat : ..............................................................................................
Telepon / HP : ..............................................................................................
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CATATAN APRESIASI
Puasa Paraf
Shalat Fardhu
Hari/Tanggal Rmd Ramadhan Nilai
S Z A M I Ortu Guru
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Total Nilai
Nilai Rata-Rata
Guru Penilai,
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CATATAN APRESIASI
IBADAH SUNNAH RAMADHAN 1444 H
Puasa Paraf
Shalat Fardhu
Guru Penilai,
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CATATAN APRESIASI
IBADAH TADARUS DAN TAHFIDZ QUR’AN RAMADHAN 1444 H
Puasa Paraf
Shalat Fardhu
Hari/Tanggal Rmd Ramadhan Nilai
S Z A M I Ortu Guru
1
Guru Penilai,
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PESANTREN
RAMADHAN
DINAS PENDIDIKAN PROVINSI SUMATERA 29
1444 H / 2023 M
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Keterangan :
* : Nomor ayat yang sudah hafal
** : Setiap satu surat hafal harus
*** : Setoran hafalan minimal
Masing-masing kelas atau Orang tua atau wali
Penguji Tahfidz
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Kepala Sekolah Koordinator Tahfidz
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NIP. NIP.
Paraf**
Tanggal
No Juz No Surat Nama Surat Jml Ayat No Ayat*
Orang Setoran***
Guru
Tua
1 2 3 4 5 6 7 8 9 10
58 Al-Mujadilah 22 11 12 13 14 15 16 17 18 19 20
1 21 22
1 2 3 4 5 6 7 8 9 10
Al-Hasyar 24 11 12 13 14 15 16 17 18 19 20
2 59 21 22 23 24
1 2 3 4 5 6 7 8 9 10
Al-Mumtahanah 13
3 60 11 12 13
1 2 3 4 5 6 7 8 9 10
Ash-Shaf 14
4 61 11 12 13 14
28
1 2 3 4 5 6 7 8 9 10
Al-Jumuah 11
5 62 11
1 2 3 4 5 6 7 8 9 10
Al-Munafikun 11
6 63 11
1 2 3 4 5 6 7 8 9 10
Ath-Taaghabun 11
7 64 11 12 13 14 15 16 17 18
1 2 3 4 5 6 7 8 9 10
Ath-Thalaq 12
8 65 11 12
1 2 3 4 5 6 7 8 9 10
Ath-Thahrim 12
9 66 11 12
1 2 3 4 5 6 7 8 9 10
Al-Mulk 30 11 12 13 14 15 16 17 18 19 20
10 67 21 22 23 24 25 26 27 28 29 30
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Al-Qalam 52
31 32 33 34 35 36 37 38 39 40
41 42 43 44 45 46 47 48 49 50
11 68 51 52
1 2 3 4 5 6 7 8 9 10
29
11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
Al-Haqqa 52
31 32 33 34 35 36 37 38 39 40
41 42 43 44 45 46 47 48 49 50
12 69 51 52
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19 20
Al-Maarij 44 21 22 23 24 25 26 27 28 29 30
31 32 33 34 35 36 37 38 39 40
13 70 41 42 43 44
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NIP. NIP.
Paraf**
No Tanggal
No Juz Nama Surat Jml Ayat No Ayat*
Surat Orang Setoran***
Guru
Tua
1 114 An-naas 6 1 2 3 4 5 6
2 113 Al-Falaq 5 1 2 3 4 5
3 112 Al-Ikhlas 4 1 2 3 4
4 111 Al-Lahab 5 1 2 3 4 5
5 110 An-Nashr 3 1 2 3
6 109 Al-Kaafiruun 6 1 2 3 4 5 6
7 108 Al-Kautsar 3 1 2 3
8 107 Al-Maa'un 7 1 2 3 4 5 6 7
9 106 Al-Quraisy 4 1 2 3 4
10 105 Al-Fiil 5 1 2 3 4 5
11 104 Al-Humazah 9 1 2 3 4 5 6 7 8 9
12 103 Al-'Ashir 3 1 2 3
13 102 At-Takatsur 8 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 10
14 101 Al-Qaari'ah 11
11
1 2 3 4 5 6 7 8 9 10
15 100 Al-Aadiyaat 11
11
16 99 Al-Zalzalah 8 1 2 3 4 5 6 7 8
17 98 Al-Bayyinah 8 1 2 3 4 5 6 7 8
18 97 Al-Qadar 5 1 2 3 4 5
1 2 3 4 5 6 7 8 9 10
19 96 Al-Alaq 19
11 12 13 14 15 16 17 18 19
20 95 At Tiin 8 1 2 3 4 5 6 7 8
21 94 Asy Syarh 8 1 2 3 4 5 6 7 8
1 2 3 4 5 6 7 8 9 10
22 93 Adh Dhuhaa 11
11
1 2 3 4 5 6 7 8 9 10
23 92 Al Lail 21 11 12 13 14 15 16 17 18 19 20
21
1 2 3 4 5 6 7 8 9 10
24 91 Asy Syams 15
11 12 13 14 15
1 2 3 4 5 6 7 8 9 10
25 90 Al Balad 20
11 12 13 14 15 16 17 18 19 20
1 2 3 4 5 6 7 8 9 10
26 89 Al Fajr 30 11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26 27 28 29 30
1 2 3 4 5 6 7 8 9 10
27 88 Al-Ghaasyiyah 26 11 12 13 14 15 16 17 18 19 20
21 22 23 24 25 26
1 2 3 4 5 6 7 8 9 10
28 87 Al-A'laa 19
11 12 13 14 15 16 17 18 19
1 2 3 4 5 6 7 8 9 10
29 86 Ath-Thaariq 17
30 11 12 13 14 15 16 17 18 19
Keterangan :
* : No ayat yang sudah hafal diarsir/diparaf
** : Setiap satu surat hafal harus diparaf baik guru maupun orang tua
*** : Setoran hafalan minimal satu hari satu ayat (setoran setiap minggu) kepada tim
penguji tahfidz masing-masing kelas atau orang tua atau wali
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NIP. NIP.