BUKU AKTIVITAS HARIAN

KULIAH KERJA NYATA TEMATIK

FAKULTAS TEKNIK
UNIVERSITAS PATTIMURA
TAHUN .........

Kelompok : ................................................
Dusun : ................................................
Desa/Negeri : ................................................
Kecamatan : ................................................
Kabupaten : ................................................
 IDENTITAS PESERTA KKN

No Nama Mahasiswa NIM Jabatan Fakultas

10

2
 RENCANA KEGIATAN KKN
Bulan ................ Minggu ke-1

Hari ke-
No Rencana Kegiatan
1 2 3 4 5 6 7

3
 RENCANA KEGIATAN KKN
Bulan ................ Minggu ke-1

Hari ke-
No Rencana Kegiatan
1 2 3 4 5 6 7

4
 RENCANA KEGIATAN KKN
Bulan ................ Minggu ke-2

Hari ke-
No Rencana Kegiatan
1 2 3 4 5 6 7

5
 RENCANA KEGIATAN KKN
Bulan ................ Minggu ke-2

Hari ke-
No Rencana Kegiatan
1 2 3 4 5 6 7

6
 RENCANA KEGIATAN KKN
Bulan ................ Minggu ke-3

Hari ke-
No Rencana Kegiatan
1 2 3 4 5 6 7

7
 RENCANA KEGIATAN KKN
Bulan ................ Minggu ke-3

Hari ke-
No Rencana Kegiatan
1 2 3 4 5 6 7

8
 RENCANA KEGIATAN KKN
Bulan ................ Minggu ke-4

Hari ke-
No Rencana Kegiatan
1 2 3 4 5 6 7

9
 RENCANA KEGIATAN KKN
Bulan ................ Minggu ke-4

Hari ke-
No Rencana Kegiatan
1 2 3 4 5 6 7

10
 RENCANA KEGIATAN KKN
Bulan ................ Minggu ke-5

Hari ke-
No Rencana Kegiatan
1 2 3 4 5 6 7

11
 RENCANA KEGIATAN KKN
Bulan ................ Minggu ke-5

Hari ke-
No Rencana Kegiatan
1 2 3 4 5 6 7

12
 HASIL PELAKSANAAN KEGIATAN KKN

Tandatangan
Hari/tgl/jam Uraian kegiatan Hasil Kegiatan Kelompok
Sasaran

Catatan Pembimbing/Instruktur Tanda Tangan

................................................................. Pembimbing/Instruktur
.................................................................
................................................................. ................................................

13
 HASIL PELAKSANAAN KEGIATAN KKN

Tandatangan
Hari/tgl/jam Uraian kegiatan Hasil Kegiatan Kelompok
Sasaran

Catatan Pembimbing/Instruktur Tanda Tangan

................................................................. Pembimbing/Instruktur
.................................................................
................................................................. ................................................

14
 HASIL PELAKSANAAN KEGIATAN KKN

Tandatangan
Hari/tgl/jam Uraian kegiatan Hasil Kegiatan Kelompok
Sasaran

Catatan Pembimbing/Instruktur Tanda Tangan

................................................................. Pembimbing/Instruktur
.................................................................
................................................................. ................................................

15
 HASIL PELAKSANAAN KEGIATAN KKN

Tandatangan
Hari/tgl/jam Uraian kegiatan Hasil Kegiatan Kelompok
Sasaran

Catatan Pembimbing/Instruktur Tanda Tangan

................................................................. Pembimbing/Instruktur
.................................................................
................................................................. ................................................

16
 HASIL PELAKSANAAN KEGIATAN KKN

Tandatangan
Hari/tgl/jam Uraian kegiatan Hasil Kegiatan Kelompok
Sasaran

Catatan Pembimbing/Instruktur Tanda Tangan

................................................................. Pembimbing/Instruktur
.................................................................
................................................................. ................................................

17
 HASIL PELAKSANAAN KEGIATAN KKN

Tandatangan
Hari/tgl/jam Uraian kegiatan Hasil Kegiatan Kelompok
Sasaran

Catatan Pembimbing/Instruktur Tanda Tangan

................................................................. Pembimbing/Instruktur
.................................................................
................................................................. ................................................

18
 PENDANAAN KEGIATAN KKN

Sumber Jumlah
No Hari / Tgl Kegiatan
Dana (Rp) Dana (Rp)

19
 PENDANAAN KEGIATAN KKN

Sumber Jumlah
No Hari / Tgl Kegiatan
Dana (Rp) Dana (Rp)

20
 PENDANAAN KEGIATAN KKN

Sumber Jumlah
No Hari / Tgl Kegiatan
Dana (Rp) Dana (Rp)

21
 PENDANAAN KEGIATAN KKN

Sumber Jumlah
No Hari / Tgl Kegiatan
Dana (Rp) Dana (Rp)

22
 SURAT IJIN MENINGGALKAN LOKASI KKN

Kepada:

Yth. UPT KKN

Di
tempat

Yang bertanda tangan di bawah ini:

Nama : ................................................
NIM : ................................................
Fakultas : ................................................
Program Studi : ................................................
Kelompok : ................................................
Lokasi KKN : ................................................

Mohon ijin meninggalkan kegiatan KKN pada hari .....................................

tanggal ............................................., pukul……………………,dengan alasan :
.....................................................................................................................
.....................................................................................................................

Demikian permohonan ijin ini dibuat dan kepada pihak-pihak yang bersangkutan
harap menjadi maklum.

........................., ......, .................., 2019

Mengetahui,
Pembimbing/Instruktur Pemohon,

.................................... ..................................
NIP. NIM.

23
 SURAT IJIN MENINGGALKAN LOKASI KKN

Kepada:

Yth. UPT KKN

Di
tempat

Yang bertanda tangan di bawah ini:

Nama : ................................................
NIM : ................................................
Fakultas : ................................................
Program Studi : ................................................
Kelompok : ................................................
Lokasi KKN : ................................................

Mohon ijin meninggalkan kegiatan KKN pada hari .....................................

tanggal ............................................., pukul……………………,dengan alasan :
.....................................................................................................................
.....................................................................................................................

Demikian permohonan ijin ini dibuat dan kepada pihak-pihak yang bersangkutan
harap menjadi maklum.

........................., ......, .................., 2019

Mengetahui,
Pembimbing/Instruktur Pemohon,

.................................... ..................................
NIP. NIM.

24
 SURAT IJIN MENINGGALKAN LOKASI KKN

Kepada:

Yth. UPT KKN

Di
tempat

Yang bertanda tangan di bawah ini:

Nama : ................................................
NIM : ................................................
Fakultas : ................................................
Program Studi : ................................................
Kelompok : ................................................
Lokasi KKN : ................................................

Mohon ijin meninggalkan kegiatan KKN pada hari .....................................

tanggal ............................................., pukul……………………,dengan alasan :
.....................................................................................................................
.....................................................................................................................

Demikian permohonan ijin ini dibuat dan kepada pihak-pihak yang bersangkutan
harap menjadi maklum.

........................., ......, .................., 2019

Mengetahui,
Pembimbing/Instruktur Pemohon,

.................................... ..................................
NIP. NIM.

25
 SURAT IJIN MENINGGALKAN LOKASI KKN

Kepada:

Yth. UPT KKN

Di
tempat

Yang bertanda tangan di bawah ini:

Nama : ................................................
NIM : ................................................
Fakultas : ................................................
Program Studi : ................................................
Kelompok : ................................................
Lokasi KKN : ................................................

Mohon ijin meninggalkan kegiatan KKN pada hari .....................................

tanggal ............................................., pukul……………………,dengan alasan :
.....................................................................................................................
.....................................................................................................................

Demikian permohonan ijin ini dibuat dan kepada pihak-pihak yang bersangkutan
harap menjadi maklum.

........................., ......, .................., 2019

Mengetahui,
Pembimbing/Instruktur Pemohon,

.................................... ..................................
NIP. NIM.

26
 CATATAN –CATATAN:

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 CATATAN –CATATAN:

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