SMP ISLAM AL-AZHAR KELAPA GADING JAKARTA

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ALIH TANGAN KASUS

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ALIH TANGAN KASUS
Nama Siswa
Kelas
Jenis Kelamin*
Waktu
Pemberi Rujukan
Pihak Rujukan*
Bidang
Nama Petugas Pihak Dirujukan
Masalah Siswa

Data yang Dilampirkan

Hasil Rujukan

Evaluasi dan Tindak Lanjut

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:L/P
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Catatan: * Pilih salah satu

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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