FORMAT EVALUASI

PERANGKAT DESA/KELURAHAN/RT
KULIAH KERJA NYATA (KKN) MANDIRI TAHAP II
UNIVERSITAS MUHAMMADIYAH BENGKULU
TAHUN 2020

Nama Mahasiswa : ………………………………………………………………………………………….

Desa/Kelurahan : ...................................................................................................
RT/RW : ...................................................................................................
Kecamatan : ...................................................................................................
Kabupaten/Kota : ...................................................................................................

A. Program K K N
1. Rencana program, ketercapaian program dan kendala pelaksanaan program.

BENTUK WAKTU TEMPAT CAPAIAN

NO PROGRAM KENDALA
KEGIATAN PELAKSANAAN PELAKSANAAN (%)
1 1.
2.
3.
4.
2 1.
2.
3.
4.
3 1.
2.
3.
4.
4 1.
2.
3.
4.
 2. Upaya mengatasi kendala pelaksanaan program yang telah disusun.

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......................, 2020

Kepala Desa/RT/Lurah

CAP DAN TANDA TANGAN

Catatan Tambahan

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