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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

Kepala Sekolah,

............................................
NIP.

: SR 09/IX
: Ayah
: VIII
: Yogyakarta
Jawaban Responden /

Keterangan

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Yogyakarta, 31 Oktober 2009
Perencana Kegiatan,

Suratma
NIP. .

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