KEMENTERIAN AGAMA
KANTOR KABUPATEN GARUT
KELOMPOK KERJA PENGAWAS PENDIDIKAN AGAMA ISLAM
Jalan pahlawan No. 65 Telp 0261-233537 Fax 233937 Kode Pos 44151
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INSTRUMEN
SUPERVISI AKADEMIK GURU PAI TK, SD, SMA, SMK/SDLB, SMPLB, SMALB, SMKLB
SEMESTER : I/II
TAHUN PELAJARAN :...................../....................
I. IDENTITAS GURU PAI DI SEKOLAH
1. Nama Lengkap (dengan gelar) :.....................................................................
2. NIP : .....................................................................
3. NUPTK/NIGNP*) : .....................................................................
4. NIK/No. KTP : .....................................................................
5. Tempat Lahir : .....................................................................
6. Tgl./bln/thn Lahir : .....................................................................
7. Jenis kelamin : .....................................................................
8. Nama Ibu Kandung : .....................................................................
9. No. Hp : .....................................................................
10. Email pribadi : .....................................................................
11. Alamat Rumah : .....................................................................
12. Kp. : .....................................................................
13. RT/RW : .....................................................................
14. Desa : .....................................................................
15. Kecamatan : .....................................................................
Kabupaten : .....................................................................
