INSTRUMEN MONITORING DAN EVALUASI

PENDATAAN DAPODIKDAS
DINAS PENDIDIKAN KABUPATEN BLITAR TAHUN 2019

Nama Sekolah : ......................................................................

NPSN : ......................................................................
Alamat Sekolah : ......................................................................
Nama Kepala Sekolah : ......................................................................
Nama Operator Dapodik : ......................................................................
Nama Unit Data Sarana dan Prasarana Sekolah : ......................................................................
Nama Unit Data Siswa/ Peserta Didik : ......................................................................
Nama Data Unit Pembelajaran : ......................................................................
Unit Sarana Komunikasi : ......................................................................
*) Cocokkan dengan SK Tim Dapodik Sekolah

A. DATA SATUAN PENDIDIKAN

1. Kurikulum yang diterapkan di sekolah : KTSP/ K13/ Campuran
2. Status Kepemilikan : ................................................................................
3. Nomor dan tanggal SK Ijin Operasional : ................................................................................
4. Bukti fisik Nomor dan tanggal SK Ijin Operasional : ada / tidak
5. Nomor dan tanggal SK Ijin Pendirian Sekolah : .........................................................................
6. Bukti fisik Nomor dan tanggal SK Ijin Pendirian Sekolah : ada / tidak
7. Nomor Rekening BOS : ................................................................................
8. Nama Bank : ................................................................................
9. Nama KCP/Unit : ................................................................................
10. Atas Nama Rekening : ................................................................................
11. Luas Tanah dan status : ................................................... milik / bukan milik
12. No. Telp Sekolah : ................................................................................
13. Email : ................................................................................
14. Website : ................................................................................
*) Cocokkan antara data dapodik yang di entri oleh operator dengan kondisi riil di lembaga
(lihat SPTJM)

B. SARANA DAN PRASARANA

1. Ada berapa jenis sarana di sekolah anda : ................................................................................
2. Prasarana apa saja yang berdasarkan kondisi rusak berat :
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
 ..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................

3. Prasarana apa saja yang berdasarkan kondisi rusak sedang :

..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
*) Cocokkan antara data dapodik yang di entri oleh operator dengan kondisi riil di lembaga
(lihat SPTJM)

C. GURU DAN TENAGA KEPENDIDIKAN

1. Berapa jumlah PTK Guru di sekolah anda ?
- PNS : ......................................................
- Non PNS : ......................................................
2. Berapa jumlah PTK non Guru di sekolah anda ?
PNS : ......................................................
Non PNS : ......................................................
*) Cocokkan antara data dapodik yang di entri oleh operator dengan kondisi riil di lembaga
(lihat SPTJM)

D. ROMBONGAN BELAJAR
1. Berapa jumlah rombongan belajar di sekolah anda? .............................. Sebutkan dengan
masing-masing jumlah siswa
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
 ..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................

2. Berapa total jumlah siswa pada sekolah anda : ...............................................................................

E. CATATAN HASIL MONITORING (diisi oleh petugas monitoring)

1. Apakah data yang dientri pada aplikasi dapodik sudah sesuai dengan kondisi riil di lembaga ?
Sesuai / tidak sesuai. (sebutkan)
2. Apa kendala/permasalahan di lembaga? (sebutkan)
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
Ket : Monitoring menggunakan alat bantu pencocokan data antara aplikasi dapodik, SPTJM dan
kondisi riil di lembaga

Responden / Kepala Sekolah

.......................................................