Post on 30-Jun-2015
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KEMENTERIAN AGAMAKELOMPOK KERJA PENGAWAS PAI (POKJAWAS PAI)
KANTOR KABUPATEN CILACAPAlamat : Jalan DI. Panjaitan No.44 Telp. (0282)531155 Cilacap
PEMANTAUAN PELAKSANAAN ULANGAN TENGAH SEMESTER I/II
TAHUN PELAJARAN ........... / ...........
1. Nama Sekolah/Madrasah : ..................................................................................................
2. Status Sekolah/Madrasah : ..................................................................................................
3. Alamat Sekolah/Madrasah : ..................................................................................................
4. Hari, Tanggal : ..................................................................................................
5. Mata Pelajaran : ..................................................................................................
6. Pelaksanaan Jam Ke : ..................................................................................................
Pukul : ..................................................................................................
7. Jumlah Peserta Ulangan Umum :
KELASJUMLAH
PESERTAHADIR TIDAK HADIR KETERANGAN
I
II
III
IV
V
VI
JUMLAH
8. Jumlah Naskah UTS I/II : Cukup / Lebih / Kurang
9. Naskah UTS I/II : Dicetak / Distensil / Diketik / Ditulis Tangan
10. Naskah UTS I/II : Jelas / Kurang Jelas / Tidak Jelas
11. Besar Anggaran UTS I/II : Rp ........................... / Siswa
12. Sumber Dana UTS I/II :
a. Dari APBD II : Rp ........................... / Siswa
b. Dari Dana BOS : Rp ........................... / Siswa
c. Dari Komite Sekolah : Rp ........................... / Siswa
13. Kejadian-kejadian Penting : ..................................................................................................
..................................................................................................
14. Kesan-kesan : ..................................................................................................
..................................................................................................
Kepala Madrasah
______________________________
NIP: .............................................
Cilacap, .........................................................
Pengawas
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NIP: .............................................................