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LAPORAN BULANAN

PENYULUH AGAMA ISLAM (NON PNS) MUDA/MADYA

PELAKSANAAN BIMBINGAN PENYULUH AGAMA ISLAM

BULAN ....................................................... 2015

DAFTAR ISI

* REKAPITULASI LAPORAN BULANAN 

* LAPORAN PER KEGIATAN........................................................

* MATERI PENYULUHAN                                                

* DAFTAR HADIR PESERTA PENYULUHAN               

* DOKUMENTASI/FOTO KEGIATAN                          

OLEH :

NAMA LENGKAP             : .............................................................................................

JABATAN                            : .............................................................................................

ALAMAT RUMAH            : .............................................................................................

NOMOR HP/TELP            : .............................................................................................

NAMA & ALAMAT

KELOMPOK BINAAN    : a. .............................................................................................

                                                   .............................................................................................

                                             : b. ............................................................................................

                                                    ............................................................................................

                                             : c. .............................................................................................

                                                  .............................................................................................

                                               

                                                                               

LAPORAN KEGIATAN PENYULUHAN

PENYULUH AGAMA ISLAM (NON PNS) MUDA MADYA

KANTOR KEMENTRIAN AGAMA KABUPATEN BANJARNEGARA

TAHUN 2015

NAMA PENYULUH                                           : .........................................................

TEMPAT PENYULUHAN                                 : .........................................................

HARI/TANGGAL PENYULUHAN                  : ................................................ 2015

WAKTU PENYULUHAN                                   : Jam ........... s/d ...........

SASARAN PENYULUHAN                                               : - Orang Tua

-          Remaja

-          Anak-anak

JUMLAH PESERTA                                            : ..................... Orang

POKOK MATERI YANG DISAMPAIKAN    : ........................................................

EVALUASI KEGIATAN                                       : .....................................................

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

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

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

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

MATERI PENYULUHAN                                    : TERLAMPIR

DOKUMENTASI                                                   : TERLAMPIR

DAFTAR HADIR PESERTA                                 : TERLAMPIR

                                                                                  .............................................. 2015

BUKTI KEHADIRAN                                                                          PENYULUH

TELAH HADIR DAN MELAKSANAKAN

PENYULUHAN SEBAGAIMANA TERSEBUT DIATAS

PROFIL

KELOMPOK BINAAN TETAP

PENYULUH AGAMA ISLAM NON PNS

KANTOR KEMENTRIAN AGAMA KABUPATEN BANJARNEGARA

TAHUN 2015

NAMA PENYULUH                                                           : ........................................................................

NAMA KELOMPOK BINAAN                                        : ........................................................................

NOMOR STATISTIK                                                          : ........................................................................

ALAMAT                                                                              : RT . .... RW . .... DESA/KEL : ............................

                                                                                                  KEC. ........................... KAB. BANJARNEGARA

                                                                                                  TELP/HP. .......................................................

NAMA PIMPINAN                                                           : .....................................................................

OBYEK BINAAN                                                                 : - Orang Tua

       -Remaja

        -Anak-anak

JENIS KEGIATAN                                                               : PENGAJIAN

                                                                                                  BACA TULIS AL-QUR’AN (BTA)

                                                                                                  DISKUSI

                                                                                                  ................................................

TEMPAT KEGIATAN                                                         : MASJID/MUSOLAH

                                                                                                  MAJELIS TAKLIM/ TPQ

                                                                                                  MADRASAH DINIYAH

                                                                                                  RUMAH WARGA

                                                                                                  TEMPAT LAINYA

VOLUME KEGIATAN                                                       : ...................... X SELAPANAN