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. .