21
32 SALINAN  -  DAFTAR USUL PENETAPAN ANGKA KREDIT PENGAWAS SEKOLAH MUDA  NOMOR : Instansi : ……………………………….. Masa penilaian Blan…………..s!" ……………… NO KETERANGAN PERORANGAN 1 N a m a 2 N I P 3 NUPTK ` 4 Nomo S! " Ka #$ P!%a &a " ' T !m(a # )a* T a*%% a+ La, "  6 !*". K!+am"* P!*) ")"a * a *% #! +a, )"(! ,"#$ *%a* A*%a K!)" #*a Pa*% a#/ Go+o*% a* R$a* %/ TMT aa #a* P!* %a&a . S!o+ a, /TMT 10 Ma .a K! 5a Go+ o*%a * Lama Ba$ 11 !*" . P!%a&a . S!o+a, 12 U*"# K!5a UNSUR #ANG DINILAI NO UNSUR$ SUB UNSUR DAN BUTIR KEGIATAN ANGKA KREDIT MENURUT INSTANSI PENGUSUL TIM PENILAI LAMA BARU %UMLAH LAMA BARU %UMLAH 1 2 3 4 ' 6 I UNSUR UTAMA & PENDIDIKAN  A M!*%"$#" (!* )")"a* 7oma+ )a* m!m(!o+!, %!+a/"5a8a, 1 Do#o / S(!."a+". 2 2 Ma%" .# ! /S(!."a+". 1 3 Sa 5 a*a/ D" (+ oma I9 B : 1 +ama* a + !" , ) a" 60 5 am 2 +ama* a a* #a a 641 - 60 5am 3 +ama* a a* #a a 4 1 - 6 40 5am 4 +ama* a a* #a a 16 1 - 4 0 5am ' +ama* a a*#a a 1 - 160 5am 6 +ama* a a*#a a 3 0 - 0 5am M!*%"$#" P!*)")"a* )a* (!+a#",a* 7$*%."o*a+ ;a+o* (!*%a&a. .!o+a, )a* m!m(!o+!, S$a# Ta*)a Tama# P!*)")"a* )a* P!+a#",a* <STTPP= M!*%"$#" (!*)")"a* )a* (!+a#",a* 7$*%."o*a+ .!#a m!m(!o+!, .$a# #a*)a #ama# (!*)")"a* )a* (!+a#",a* <STTPP=

Lampiran II a Iic Dupak

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SALINAN  -

 

DAFTAR USUL

PENETAPAN ANGKA KREDIT PENGAWAS SEKOLAH MUDA

  NOMOR :

Instansi : ……………………………….. Masa penilaian Blan…………..s!" ………………

NO KETERANGAN PERORANGAN

1 N a m a

2 N I P

3 NUPTK `

4 Nomo S!" Ka#$ P!%a&a"

' T!m(a# )a* Ta*%%a+ La," 

6 !*". K!+am"*

P!*)")"a* a*% #!+a, )"(!,"#$*%a* A*%a K!)"#*a

Pa*%a#/Go+o*%a* R$a*%/TMT

aa#a* P!*%a&a. S!o+a,/TMT

10 Ma.a K!5a Go+o*%a*Lama

Ba$

11 !*". P!%a&a. S!o+a,

12 U*"# K!5a

UNSUR #ANG DINILAI

NO UNSUR$ SUB UNSUR DAN BUTIR KEGIATAN

ANGKA KREDIT MENURUT

INSTANSI PENGUSUL TIM PENILAI

LAMA BARU %UMLAH LAMA BARU %UMLAH

1 2 3 4 ' 6

I UNSUR UTAMA

& PENDIDIKAN

 A M!*%"$#" (!*)")"a* 7oma+ )a* m!m(!o+!, %!+a/"5a8a,

1 Do#o/ S(!."a+". 2

2 Ma%".#!/S(!."a+". 1

3 Sa5a*a/ D"(+oma I9

B

:

1 +ama*a +!", )a" 60 5am

2 +ama*a a*#aa 641 - 60 5am

3 +ama*a a*#aa 41 - 640 5am

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6 +ama*a a*#aa 30 - 0 5am

M!*%"$#" P!*)")"a* )a* (!+a#",a* 7$*%."o*a+ ;a+o*(!*%a&a. .!o+a, )a* m!m(!o+!, S$a# Ta*)a Tama#P!*)")"a* )a* P!+a#",a* <STTPP=

M!*%"$#" (!*)")"a* )a* (!+a#",a* 7$*%."o*a+ .!#am!m(!o+!, .$a# #a*)a #ama# (!*)")"a* )a* (!+a#",a*<STTPP=

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UNSUR #ANG DINILAI

NO UNSUR$ SUB UNSUR DAN BUTIR KEGIATAN

ANGKA KREDIT MENURUT

INSTANSI PENGUSUL TIM PENILAI

LAMA BARU %UMLAH LAMA BARU %UMLAH

1 2 3 4 ' 6

' PENGAWASAN AKADEMIK DAN MANA%ERIAL  

 A P!*$.$*a* (o%am

1 m!*$.$* (o%am (!*%a&a.a*

B P!+a.a*aa* (o%am

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3 m!+a.a*aa* (!*"+a"a* "*!5a %$$

: E>a+$a." ,a."+ (!+a.a*aa* (o%am (!*%a&a.a*

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E P!+a.a*aa* #$%a. !(!*%a&a.a* )" )a!a, ,$.$.

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UNSUR #ANG DINILAI

NO UNSUR$ SUB UNSUR DAN BUTIR KEGIATAN

ANGKA KREDIT MENURUT

INSTANSI PENGUSUL TIM PENILAI

LAMA BARU %UMLAH LAMA BARU %UMLAH

1 2 3 4 ' 6

a )a+am !*#$ $$

5

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2

a )a+am !*#$ $$

: M!m$a# aa "*o>a#"7 

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a Ka#!%o" Kom(+!.

Ka#!%o" S!)!,a*a

2 M!*;"(#aa* aa .!*"

a Ka#!%o" om(+!.

Ka#!%o" .!)!,a*a

3

a

%UMLAH

%UMLAH UNSUR UTAMA

II UNSUR PENUN%ANG

PENUN%ANG TUGAS PENGAWAS SEKOLAH

 A

1 M!*%"$#" .!m"*a/+oaaa? .!a%a" @

a *aa .$m! 

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; (!.!#a

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a K!#$a

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P!*!5!ma,a*/(!*a)$a* $$ )a* a#a$ aa "+m"a, )"")a*% (!*)")"a* 7oma+/(!*%a&a.a*

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M!*!5!ma,a*/m!*a)$a* $$ )" ")a*% (!*)")"a*7oma+/(!*%a&a.a* a*% #")a )"($+"a."a*

)a+am !*#$ maa+a, "+m"a, a*% )"!#a,$" o+!,("m("*a* $*"#

M!*%"$#" P!*%!ma*%a* P!*$.$*a* S#a*)a?P!)oma*? )a* .!5!*".*a

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P!a* .!#a )a+am .!m"*a/+oaaa )" ")a*% (!*)")"a*7oma+/!(!*%a&a.a* .!o+a,

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UNSUR #ANG DINILAI

NO UNSUR$ SUB UNSUR DAN BUTIR KEGIATAN

ANGKA KREDIT MENURUT

INSTANSI PENGUSUL TIM PENILAI

LAMA BARU %UMLAH LAMA BARU %UMLAH

1 2 3 4 ' 6

B K!a*%%o#aa* )a+am o%a*".a." (o7!."

)

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:

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; #"*%a# a$(a#!*/o#a

2 M!*)a(a# (!*%,a%aa* Sa#a La*;a*a Kaa Sa#a

a .!($+$, #a,$*

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; #"%a ($+$, #a,$*

1

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a Do#o/S(!."a+". 2 <S3=

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; Sa5a*a/D"(+oma I9 <S1=

%UMLAH UNSUR PENUN%ANG

%UMLAH UNSUR UTAMA DAN UNSUR PENUN%ANG

M!*5a)" a*%%o#a )a+am o%a*".a." (o7!." (!*%a&a. a#a$!+om(o !5a (!*%a&a.? .!a%a" @

K!a*%%o#aa* )a+am #"m (!*"+a" a*%a !)"# 5aa#a* 7$*%."o*a+P!*%a&a. S!o+a,

M!*5a)" a*%%o#a #"m (!*"+a" 5aa#a* 7$*%."o*a+ P!*%a&a.S!o+a,

M!+a.a*aa* #$%a. .!a%a" Koo)"*a#o P!*%a&a.S!o+a,

m!m"m"*% +oma/om(!#!*." o+"m("a)! ma#a(!+a5aa* )a* .!5!*".*a

(a)a +oma %$$/!(a+a .!o+a,/(!*%a&a. .!o+a,!(!.#a."

M!m(!o+!, %!+a/"5a8a, a*% #")a .!.$a" )!*%a* ")a*%a*% )"am($*a

Do#o !,oma#a*/,o*o". ;a$.a )a" +!ma%a a*%#!a!)"#a."/ )"a$" *!%aa

M!m(!o+!, "5a8a,/%!+a a*% #")a .!.$a" )!*%a*")a*% #$%a.*a

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Bti* +e,iatan -en-an, -aatan "i atas!"i a/a0

1 2 3 4 ' 6

%UMLAH UNSUR UTAMA DAN UNSUR PENUN%ANG

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12 Di34*et 5an, ti"a+ pe*l

III LAMPIRAN PENDUKUNG DUPAK

 

1 S$a# (!*a#aa* m!*%"$#" (!*)")"a*

2 S$a# (!*a#aa* m!+a$a* !%"a#a* (!*%a&a.a* aa)!m" )a* ma*a5!"a+

3 S$a# (!*a#aa* m!+a$a* !%"a#a* (!*%!ma*%a* (o7!."

4 S$a# (!*a#aa* m!+a$a* !%"a#a* (!*$*5a*%

I6 7ATATAN PE%ABAT PENGUSUL

1

2

3

4 )a* .!#!$.*a

<5aa#a*=

<*ama (!5aa# (!*%$.$+=

NIP @

6 7ATATAN ANGGOTA TIM PENILAI

1

2

3

4 )a* .!#!$.*a

<*ama (!*"+a" I =

NIP @

<*ama (!*"+a" II =

NIP @

6I 7ATATAN KETUA TIM PENILAI

1

2

3 K!#$a T"m P!*"+a"

4 )a* .!#!$.*a

<*ama=

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SALINAN  -

 

DAFTAR USUL

PENETAPAN ANGKA KREDIT PENGAWAS SEKOLAH MAD#A

  NOMOR :

Instansi : ……………………………….. Masa penilaian Blan…………..s!" ………………

NO KETERANGAN PERORANGAN

1 N a m a

2 N I P

3 NUPTK `

4 Nomo S!" Ka#$ P!%a&a"

' T!m(a# )a* Ta*%%a+ La," 

6 !*". K!+am"*

P!*)")"a* a*% #!+a, )"(!,"#$*%a* A*%a K!)"#*a

Pa*%a#/Go+o*%a* R$a*%/TMT

aa#a* P!*%a&a. S!o+a,/TMT

10 Ma.a K!5a Go+o*%a*Lama

Ba$

11 !*". P!*%a&a. S!o+a,

12 U*"# K!5a

UNSUR #ANG DINILAI

NO UNSUR$ SUB UNSUR DAN BUTIR KEGIATAN

ANGKA KREDIT MENURUT

INSTANSI PENGUSUL TIM PENILAI

LAMA BARU %UMLAH LAMA BARU %UMLAH

1 2 3 4 ' 6

I UNSUR UTAMA

& PENDIDIKAN

 A M!*%"$#" (!*)")"a* 7oma+ )a* m!m(!o+!, %!+a/"5a8a,

1 Do#o/ S(!."a+". 2

2 Ma%".#!/S(!."a+". 1

3 Sa5a*a/ D"(+oma I9

B

:

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UNSUR #ANG DINILAI

NO UNSUR$ SUB UNSUR DAN BUTIR KEGIATAN

ANGKA KREDIT MENURUT

INSTANSI PENGUSUL TIM PENILAI

LAMA BARU %UMLAH LAMA BARU %UMLAH

1 2 3 4 ' 6

' PENGAWASAN AKADEMIK DAN MANA%ERIAL  

 A P!*$.$*a* (o%am

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membimbing pengawas sekolah muda dalammelaksanakan tugas pokok

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a

UNSUR #ANG DINILAI

NO UNSUR$ SUB UNSUR DAN BUTIR KEGIATAN

ANGKA KREDIT MENURUT

INSTANSI PENGUSUL TIM PENILAI

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SALINAN  -

 

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UNSUR #ANG DINILAI

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