BIODATA PESERTA BELAJAR

RUMAH QUR’AN MUHAMMADIYAH HAJI IBRAHIM

Alamat : Jl. Jend. Sudirman No.94 Rt.02 Rw.02 Ds. Tj. Kemala Kabupaten OKU Timur

‫بسم هللا الرحمن الرحيم‬

NO. : ................ KATAGORI : ORT/DWS/RMJ/ANK (Diisi Pengampu)

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

TEMP./TGL LAHIR : ...........................................................................................................

PEKERJAAN : ...........................................................................................................

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

: ...........................................................................................................

NO. TELEPHONE : ...........................................................................................................

JENIS KELAMIN : LAKI-LAKI / PEREMPUAN (Coret yang tidak perlu)

MULAI BELAJAR : ................................................. DD/MM/YY (Diisi oleh pengampu)

WAKTU BELAJAR : PAGI (09.00 s.d 11.45 WIB)

SIANG (13.00 s.d 15.15 WIB)

MALAM (Ba’da Maghrib s.d Isya)

FLEKSIBEL (Menyesuaikan) (Centang pilihan)

Martapura, ............................................ 20.....

Peserta belajar,

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