BIODATA PESERTA

BIMBINGAN PERKAWINAN CALON PENGANTIN MANDIRI

LINGKUP KANTOR KEMENTERIAN AGAMA KAB. PANGKAJENE DAN KEPULAUAN
DI KANTOR URUSAN AGAMA KEC. ....................................................
TAHUN ANGGARAN 2023

NAMA : .............................................................................................

TTL : .............................................................................................

NIK/NO. KTP : .............................................................................................

NO. HP/WA : .............................................................................................

AGAMA : .............................................................................................

EMAIL : .............................................................................................

ALAMAT : .............................................................................................

PENDIDIKAN TERAKHIR : .............................................................................................

DATA CALON SUAMI / ISTRI *

NAMA : .............................................................................................

TTL : .............................................................................................

NIK/ NO. KTP : .............................................................................................

NO. HP/WA : .............................................................................................

AGAMA : .............................................................................................

EMAIL : .............................................................................................

ALAMAT : .............................................................................................

PENDIDIKAN TERAKHIR : .............................................................................................

TANGGAL RENCANA MENIKAH : .............................................................

Menyatakan bersedia mengikuti Bimbingan Perkawinan Calon Pengantin Mandiri

di KUA ............................................ tanggal .................................................... 2023.

..........................., .......... 2023

Peserta,

_________________________
(Nama dan Tanda Tangan)

*CORET YANG TIDAK PERLU

 Daftar Hadir Peserta
Kegiatan Bimbingan Perkawinan Calon Pengantin Mandiri
KUA ........................................, .............................. 2023

No Nama Calon Suami / NIK Nama Calon Istri / NIK Tanggal Rencana Tanda Tangan Calon Tanda Tangan Calon
Menikah Suami Istri
1 2 3 4 5 6

........................., .......................... 2023

Mengetahui:
Kepala KUA ....................................... Pembimbing Catin,

............................................................. .............................................................
NIP. ...................................................... NIP. ......................................................
 BIODATA PEMBIMBING
BIMBINGAN PERKAWINAN CALON PENGANTIN MANDIRI
LINGKUP KANTOR KEMENTERIAN AGAMA KAB. PANGKAJENE DAN KEPULAUAN
DI KANTOR URUSAN AGAMA KECAMATAN ...........................................
TAHUN ANGGARAN 2023

NAMA : .............................................................................................
TTL : .............................................................................................
NIP : .............................................................................................
NIK/No. KTP : .............................................................................................
PANGKAT/GOL. : .............................................................................................
ALAMAT : .............................................................................................
PEKERJAAN : .............................................................................................
NO. HP/WA : .............................................................................................
EMAIL : .............................................................................................
RIWAYAT PENDIDIKAN
SD/MI : .............................................................................................
SMP/MTS : .............................................................................................
SMA/MA : .............................................................................................
SARJANA/S1 : .............................................................................................
MAGISTER/S2 : .............................................................................................
DOKTOR/S3 : .............................................................................................
PENGALAMAN 1. .........................................................................................
PEKERJAAN 2. .........................................................................................
3. .........................................................................................
4. .........................................................................................
MATERI YANG : .............................................................................................
DISAMPAIKAN ...............................................................................................
PESAN DAN KESAN : .............................................................................................
...............................................................................................

......................, ............... 2023

Pembimbing,

_________________________
(Nama dan Tanda Tangan)
 MATERI BIMBINGAN PERKAWINAN MANDIRI
LINGKUP KANTOR KEMENTERIAN AGAMA KAB. PANGKAJENE DAN KEPULAUAN
DI KANTOR URUSAN AGAMA ...............................................
TAHUN ANGGARAN 2023

HARI/TANGGAL : ..................., .......................... 2023

NO WAKTU MATERI PEMATERI KET.

1 2 3 4 5

1 15 menit Pembukaan, pre tes Penghulu / Penyuluh

Merencanakan Perkawinan yang

2 30 menit Kokoh menuju Keluarga Sakinah Penghulu / Penyuluh

3 30 menit Mengelola Konflik Keluarga Penghulu / Penyuluh

4 30 menit Dinamika Perkawinan Penghulu / Penyuluh

5 30 menit Menjaga Kesehatan Reproduksi Penghulu / Penyuluh

Membangun Generasi Berkualitas

6 30 menit Bebas Stunting Penghulu / Penyuluh

7 15 menit Pos Tes, Penutup Penghulu / Penyuluh

180 menit

..........................., .......................... 2023

Kepala KUA ......................................

........................................................
NIP. ...............................................
STANDAR LAPORAN PELAKSANAAN BIMBINGAN PERKAWINAN MANDIRI

1 Biodata catin

2 Daftar hadir catin

3 Materi Bimwin

4 Nota konsumsi

5 Foto kegiatan