K U E S I O N E R M O N I TO R I N G DA N E VA LUA S I

P R O G R A M M A H A S I S WA W I R A U S A H A ( P M W )
U N I V E R S I TA S N E G E R I S U R A B AYA
2017

Petunjuk menjawab :
Mengisi untuk pertanyaan terbuka, dan
Mencoret yang tidak perlu untuk pertanyaan pilihan

I. UMUM

1. Fakultas : ........................................................................................
2. Nama Kegiatan Usaha : ........................................................................................
.........................................................................................................................................
3. Nama Ketua PMW : ........................................................................................
4. Bidang/jenis Usaha : ........................................................................................
5. Anggota : 1. ....................................................................................
2. ....................................................................................
6. Mulai Usaha Tgl,Bln,Thn : ........................................................................................
7. Alamat Usaha : ........................................................................................
........................................................................................
........................................................................................
........................................................................................
Telepon/HP .................................. Fax ..........................
Surel ...............................................................................
8. Nama Pembimbing : ........................................................................................
9. No. Telepon / HP : ........................................................................................

II. PEMASARAN

1. Jenis Produk usaha : ........................................................................................

2. Omzet penjualan per bulan
Jenis Produk Jumlah (unit) Jumlah (Rp)

3. Sasaran Konsumen : Mahasiswa / Umum

4. Wilayah Pemasaran : Kampus / luar kampus
Penjelasan ......................................................................................................................
................................................................................................................
5. Rencana Penjualan / Bulan : ................... Unit
6. Prospek Pasar : Baik sekali / Baik / Cukup/Kurang/Tidak tahu
Penjelasan ......................................................................................................................

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7. Manfaat Sosial : Penyerapan tenaga kerja/.............................................
8. Jumlah pesaing lokal : Tidak ada / Ada . Unit Usaha.
9. Jalur Penjualan : Langsung / Tidak langsung
Penjelasan ......................................................................................................................
................................................................................................................
10. Promosi : Sudah / belum / tidak perlu
Penjelasan ......................................................................................................................
................................................................................................................
11. BagaimanacaraAndamemperluaspasar? ......................................................
.................................................................................................................
12. Apakah Anda mengalami kesulitan dalam memasarkan produk Anda?
Penjelasan ......................................................................................................................
................................................................................................................

III. ASPEK ORGANISASI & PERSONALIA

1. Pembagian tugas Pekerjaan : Ada / Belum / Serabutan

2. Jumlah Anggota/Tenaga kerja : .. orang
3. Status Anggota/Tenaga Kerja :
Mahasiswa.... Orang (Rata-rata semester = ....)
Bukan Mahasiswa.... Orang (Rata-rata umur = .... )
4. Apakah Anda menghadapi masalah dalam bidang manajemen?..............................
Penjelasan ......................................................................................................................
................................................................................................................

IV. PRODUKSI / OPERASI

1. Luas lahan usaha : ....................m2

2. Status lahan usaha Anda:
a. Milik sendiri
b. Sewa/kontrak
c. Lainnya .....................................................................................................................
3. Jenis barang/jasa : industri/perdagangan/pertanian/.........................
4. Kapasitas Produksi / Bulan : ........................................................................................
5. Ketersediaan Bahan Baku : mudah/sedang/sulit
Penjelasan ......................................................................................................................
................................................................................................................
6. Fasilitas/saranaProduksi : Memadai/ cukup / kurang/ tidakmemadai
Penjelasan ......................................................................................................................
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V. KEUANGAN

1. Perkiraan nilai aset saat ini:

a. Mesin : Rp.........................
b. Peralatan : Rp.........................
c. Lainnya : Rp.........................
2. Jumlah modal kerja
a. Modal sendiri :Rp.............................
b. Modal PMW : Rp.............................
c. Modal Pinjaman : Rp.............................
d. Modal lainnya : Rp.............................
e. TOTAL : Rp.............................
3. Rata-rata omset penjualan per bulan :Rp......................................................
4. Trend perkembangan omset penjualan usaha per bulan?
a. Cenderung naik, kira-kira.................% per bulan
b. Cenderung turun, kira-kira...............% per bulan
c. Cenderung konstan

5. Rata-rata total biaya yang diperlukan per bulan:

Biaya tetap : Rp........................
Biaya variable : Rp........................
Total biaya : Rp........................
6. Trend total biaya produksi per bulan?
a. Cenderung naik, kira-kira.................% per bulan
b. Cenderung turun, kira-kira...............% per bulan
c. Cenderung konstan
7. Keuntungan rata-rata / Bulan: Rp......................................................
8. Apakah Anda menghadapi permasalahan dalam bidang keuangan?
Penjelasan ......................................................................................................................
................................................................................................................
9. Apakah Anda melakukan secara rutin :
a. Pembukuan (kas harian) Ya / tidak
b. Menyusun laba rugi Ya / tidak
c. Menyusun neraca Ya / tidak
10. Apakah Anda menghadapi masalah pembukuan dan penyusunan laporan keuangan?
Penjelasan ......................................................................................................................
................................................................................................................

VI. LAIN-LAIN

1. Intensitas pembimbingan : .......................................................................................

2. Bentuk pembimbingan yang pernah dilakukan : .........................................................
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3. Prospekkeberlanjutan program : .....................................................
4. Permasalahanpokok yang dihadapi : ........................................................
5. Kekuatan (strength) : .......................................................................................
6. Kelemahan (Weaknes) : .......................................................................................
7. Peluang (Opportunity) : .......................................................................................
8. Ancaman (Threats) : .......................................................................................

9. Kebutuhan pembinaan/bantuan : .........................................................................

................................................................................................................
10. Saransaran : .......................................................................................
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__________, ____________ 2017

Pengelola Usaha Petugas Monev

______________________ ______________________
NIM NIP

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