BUKU
KEGIATAN MADRASAH DINIYAH “ ATH – THOHIRIN “
JL ALI USMAN ASEM GROWONG JAPAN
BABADAN PONOROGO
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No
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Hari dan Tanggal
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Jenis Kegiatan
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Uraian Kegiatan
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Tempat Kegiatan
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Peserta
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Ket.
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AGENDA
SURAT MASUK
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No
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Diterima Hari / Tanggal
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No. Surat
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Tanggal
Surat
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Asal Surat
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Perihal
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AGENDA
SURAT KELUAR
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No
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No. Surat
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Tanggal Surat
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Perihal
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Tujuan Surat
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Dikirim Tanggal
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Ket.
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BUKU
TAMU
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No
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Hari / Tanggal
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Nama
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Jabatan/ Pekerjaan
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Alamat / Instansi/Lembaga
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Keperluan
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Tanda Tangan
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I.
SANTRI
1.
Nama :
_______________________
2.
Tempat / tgl.lahir : _______________________
3.
Jenis Kelamin :
*Laki – laki / Perempuan
4.
Agama :
Islam
5.
Anak ke :
_______________________
6.
Alamat :
_____________________________________
_____________________________________
7.
Mulai masuk :
Tanggal :
_______________________
Di
kelas :
_______________________
II. ORANG TUA / WALI
AYAH
1.
Nama Ayah :
_______________________
2.
Pekerjaan :
_______________________
3.
Agama :
_______________________
4. Alamat :
_____________________________________
_____________________________________
IBU
1.
Nama Ibu :
_______________________
2.
Pekerjaan :
_______________________
3.
Agama :
_______________________
4. Alamat :
_____________________________________
_____________________________________
III. MENINGGGALKAN MADRASAH DINIYAH
Tanggal :
_______________________
Alasan :
_______________________
Surat Pindah :
No ………… tanggal ……………………….
![]() |
PIAGAM PENGHARGAAN YANG
PERNAH
DITERIMA :
Foto a. Bidang
______________________No. __________ 3x4 b. Bidang ______________________No. __________
IV. PENILAIAN HASIL BELAJAR
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NO
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MATA
PELAJARAN
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……/…….
Kelas : ___
Semester
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……/…….
Kelas : ___
Semester
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……/…….
Kelas : ___
Semester
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……/…….
Kelas : ___
Semester
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……/…….
Kelas : ___
Semester
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……/…
Kelas : _
Semester
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||||||
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1
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Al-Qur’an
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2
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Haf.Jus ‘amma
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3
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Hadits
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4
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Tauhid
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5
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Akhlaq
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6
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Fiqih
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7
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Tajwid
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8
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Tafsir
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9
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Nahwu
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10
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Shorof
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11
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Bahasa Arab
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12
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Prak. Ibadah
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13
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Tarih Islam
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14
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Imla’
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15
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Mahfudhot
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16
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Aswaja
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17
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Khot / Tahaji
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18
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Haf. Do’a
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19
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Tahlil
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20
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JUMLAH
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RATA-RATA
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RANGKING
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PRIBADI : AKHLAQ
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KERAJINAN
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KEAKTIFAN
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ABSEN :
SAKIT
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IZIN
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ALVA
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NAIK/TDK.
NAIK
|
Naik ke kelas ….
Tidak naik
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Naik ke kelas ….
Tidak naik
|
Naik ke kelas ….
Tidak naik
|
Naik ke kelas ….
Tidak naik
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Naik ke kelas ….
Tidak naik
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Naik ke kelas
Tidak naik
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|||||||
V.
IJAZAH
Nomor :
…………….Tanggal ………………….
Diberikan Tanggal : ………………………….
