Nama Peserta :.............................................................. Dosen Pembimbing :.....................................................
No Peserta :.............................................................. Guru Pamong :..................................................... Bidang Studi :............................................................. Lokasi PPL :......................................................
No Hari/Tanggal Catatan Kegiatan Tindak Lanjut Tanda Tangan
1
Mengetahui,
Kepala Sekolah ................ Ketua Unit PPL FKIP UNIB
(........................................) Dr. Rosane Medriati, M.Pd