KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI

AKADEMI MANAJEMEN INFORMATIKA DAN KOMPUTER

MEDAN BUSINESS POLYTECHNIC
JURUSAN ………………… INFORMATIKA
Jl. Letdjend. Jamin Ginting No. 285-287 Medan 20155 Indonesia
Telp. (061) 8216244, 8216332 Fax (061) 8216579

FORM NILAI PKL

Nama Mahasiswa : ...............................................................................................
NPM : ...............................................................................................
Program Studi : ...............................................................................................
Unit Kerja : ...............................................................................................
Tanggal Magang : .............................................s/d.............................................
Tidak Hadir : ...............................................................................................
Alasan : ...............................................................................................
Nama Instansi / Perusahaan : ...............................................................................................
Alamat Instansi / Perusahaan : ...............................................................................................

Nilai
No Kriteria Penilaian
(0-100)
1. Sikap (Kerapian, Kebersihan dan Kesopanan)
2. Disiplin (Waktu dan Peraturan)
3. Tanggung Jawab Pekerjaan
4. Kemandirian
5. Inisiatif
6. Pemahaman Terhadap Topik Kajian
7. Kinerja Tim
8. Lain - Lain
T O TAL
RATA - RATA

Nilai Keterangan
85 – 100 Sangat Memuaskan
70 – 84 Memuaskan
60 – 69 Cukup
40 – 59 Kurang
0 - 39 Sangat Kurang

Saran :......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
......................,.............................
Pembimbing / Supervisor

................................................
Nama, T.Tangan & Stempel

Document No. : F-PD1-03-15 Revision : 01 Date of Issue : 09 September 2016