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PEDOMAN WAWANCARA

UNTUK KEGIATAN KUNJUNGAN RUMAH


Nama Klien
Nama Anggota kelaurga yang
dikunjungi
Kelas
Alamat
NO
1

Uraian
Permasalahan
Kondisi fisik klien
(kesehatan, usia,
kebiasaan sehaihari klien)

Kebiasaan belajar
klien di rumah

3.

Pergaulan/hubung
an sosial dengan
anggota keluarga
- dengan orang
tua
- saudara
(adik/kakak)

4.

Pergaulan/hubung
an sosial dengan
tetangga dan
teman sebayanya.
Upaya keluarga
memotivasi belajar
klien

5.

6.

Dukungan
keluarga terhadap
belajar klien

:
:
:
:
Jawaban Responden /

Keterangan

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Mengetahui,
Kepala Sekolah

Gelumbang, Januari 2014


Guru Pembimbing

Nazirin, S. Pd., M. Si.


NIP. 19651014 198803 1 006

Zuzainah, S. Pd.
NIP. 19620601 198903 2 002

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