PENDIDIKAN TARTILUL QUR'AN

PTQ
KOORDINATOR KECAMATAN GROGOL
FORMULIR PENDAFTARAN
Yang bertanda tangan dibawah ini, saya :
1. Nama Lengkap : ............................................................................................
2. Tempat Tgl Lahir : ............................................................................................

3. Jenis Kelamin : ............................................................................................

: ............................................................................................
4. Alamat
: ............................................................................................
a. RT / RW
: ............................................................................................
b. Dukuh
: ............................................................................................
c. Desa
: ............................................................................................
d. Kecamatan : ............................................................................................
e. Kabupaten : ............................................................................................
f. Provinsi : ............................................................................................
5. No. Telp/Hp : ............................................................................................
6. Nama Wali : ............................................................................................
7. Pendidikan Terakhir : ............................................................................................
: ............................................................................................
- Formal
- Non Formal
Selanjutnya saya sanggup memenuhi / melaksanakan semua syarat-
syarat dan peraturan yang berlaku, untuk dapatnya diterima sebagai peserta
Pendidikan Tartilul Qur'an ( PTQ ).

Kediri, ________________ 2023

Yang Membuat Pernyataan

( ________________________ )
 PENDIDIKAN GURU PENGAJAR QUR'AN
(PGPQ)
KOORDINATOR KECAMATAN GROGOL

FORMULIR PENDAFTARAN
Yang bertanda tangan dibawah ini, saya :
1. Nama Lengkap : ............................................................................................
: ............................................................................................
2. Tempat Tgl Lahir
: ............................................................................................
3. Jenis Kelamin : ............................................................................................
4. Alamat : ............................................................................................
a. RT / RW : ............................................................................................
: ............................................................................................
b. Dukuh
: ............................................................................................
c. Desa
: ............................................................................................
d. Kecamatan : ............................................................................................
e. Kabupaten : ............................................................................................
f. Provinsi : ............................................................................................
: ............................................................................................
5. No. Telp. / HP
: ............................................................................................
6. Nama Wali
: ............................................................................................
7. Pendidikan Terakhir
- Formal
- Non Formal
Selanjutnya saya sanggup memenuhi / melaksanakan semua syarat-syarat dan
peraturan yang berlaku, untuk dapatnya diterima sebagai peserta Pendidikan Guru
Pengajar Qur'an (PGPQ).

Kediri, ___________________ 2023

Yang membuat Pernyataan,

( _____________________________ )