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  • 7.14 Format Hasil Kunjungan Rumah

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    Ria Wastiani
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    7.14 Format Hasil Kunjungan Rumah

    Diunggah oleh

    Ria Wastiani

    Hak Cipta:

    Attribution Non-Commercial (BY-NC)
    Tandai sebagai konten tidak pantas
    dari 1

    SMP ISLAM AL-AZHAR KELAPA GADING JAKARTA

    FORMAT HASIL
    KUNJUNGAN RUMAH

    No. Dok
    No. Revisi
    No. Terbit
    Tgl Berlaku
    Halaman

    : F/BK/14
    : 00
    :
    :
    : 1 dari 1

    LAPORAN HASIL
    KUNJUNGAN RUMAH (home visit)
    I.

    IDENTITAS SISWA
    1. N a m a
    2. Kelas/No Absen
    3. N I S

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

    II. IDENTITAS ORANGTUA


    1. Nama Ayah
    : ..............................................................................................
    2. Pekerjaan Ayah
    : ..............................................................................................
    3. Nama Ibu
    : ..............................................................................................
    4. Pekerjaan Ibu
    : ..............................................................................................
    5. Alamat Rumah
    : ..............................................................................................
    ................................................................................................
    6. Telp/ HP
    : ..............................................................................................
    III. TUJUAN KUNJUNGAN RUMAH
    ...................................................................................................................................
    ...................................................................................................................................
    IV. HASIL WAWANCARA & OBSERVASI
    ...................................................................................................................................
    ...................................................................................................................................
    ...................................................................................................................................
    ...................................................................................................................................
    V. KESIMPULAN/TINDAK LANJUT
    ...................................................................................................................................
    ...................................................................................................................................
    ...................................................................................................................................

    Mengetahui,
    Kepala Sekolah
    SMPI Al-Azhar Kelapa Gading

    Jakarta, ........................................
    Koord. Guru Bimbingan Konseling
    SMPI Al-Azhar Kelapa Gading

    Drs. H. Asmawi, M.Pd


    NIP. 343974 264720 0 002

    Dra. Kholilah
    NIP. 363574 664830 0 062

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