LEMBAR SUPERVISI DIKLAT (SIANG)

SMK CITRA MEDIKA SRAGEN

2017/2018

Hari/Tanggal Supervisi : _____________________

Jam : _____________________
Tempat Supervisi : _____________________
Pembimbing Supervisi : _____________________
Daftar Siswa
No Nama Peserta Catatan
1.

2.

3.

4.

5.

6.

Catatan :
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Pembimbing Diklat Pembimbing Supervisi

___________________ _____________________

LEMBAR SUPERVISI DIKLAT (MALAM)

 SMK CITRA MEDIKA SRAGEN
2017/2018

Hari/Tanggal Supervisi : _____________________

Jam : _____________________
Tempat Supervisi : _____________________
Pembimbing Supervisi : _____________________
Daftar Siswa
No Nama Peserta Catatan
1.

2.

3.

4.

5.

6.

Catatan :
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Telah melaksanakan tugas Pembimbing Supervisi

Pada ...........................................
Mengetahui,

___________________ _____________________