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FRM/DPD/PKL/008

KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN


INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

Nama Instansi
DAFTAR: KEHADIRAN
…………………………………………………….......................………………
PRAKTIK KERJA LAPANGAN
Alamat : …………………………………………………………….........……..............…
…………………………………………………….........………………..............
…………………………………………………….........………………..............

Periode Kegiatan (Minggu 1): 03 – 09 Februari 2020 FRM/DPD/PKL/011


DEPARTEMEN PENDIDIKAN NASIONAL
Hari / Tanggal
INSTITUT PERTANIAN BOGOR
No. Nama Mahasiswa / NIM
DIREKTORATSenin
PROGRAM DIPLOMA
Selasa Rabu Kamis Jumat Sabtu Ahad
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 1/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK


03 04 KERJA
05 06 LAPANGAN
07 08 09

1
X
Paraf Pembimbing Lapang
FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
Periode Kegiatan (Minggu 2): INSTITUT
10 – 16 Februari 2020
PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
No. Nama Mahasiswa / NIM Hari / Tanggal
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 2/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA


Senin Selasa Rabu Kamis LAPANGAN
Jumat Sabtu Ahad

10 11 12 13 14 15 16

1
X
FRM/DPD/PKL/011
Paraf Pembimbing Lapang
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Periode Kegiatan (Minggu 3): 17 – 23 Februari 2020
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 3/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN


Hari / Tanggal

No. Nama Mahasiswa / NIM Senin Selasa Rabu Kamis Jumat Sabtu Ahad

17 18 19 20 21 22 23

1
DEPARTEMEN PENDIDIKAN NASIONAL
FRM/DPD/PKL/011 X
INSTITUT PERTANIAN BOGOR
Paraf Pembimbing Lapang
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 4/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN

FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 5/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

Nama Instansi
DAFTAR: KEHADIRAN
…………………………………………………….......................………………
PRAKTIK KERJA LAPANGAN
Alamat : …………………………………………………………….........……..............…
…………………………………………………….........………………..............
…………………………………………………….........………………..............

Periode Kegiatan (Minggu 4): 24 Februari – 1 Maret 2020 FRM/DPD/PKL/011


DEPARTEMEN PENDIDIKAN NASIONAL
Hari / Tanggal
INSTITUT PERTANIAN BOGOR
No. Nama Mahasiswa / NIM
DIREKTORATSenin
PROGRAM DIPLOMA
Selasa Rabu Kamis Jumat Sabtu Ahad
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 6/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK


24 25 KERJA
26 27 LAPANGAN
28 29 01

1
X
Paraf Pembimbing Lapang
FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
Periode Kegiatan (Minggu 5): INSTITUT
02 – 08 Maret 2020
PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
No. Nama Mahasiswa / NIM Hari / Tanggal
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 7/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA


Senin Selasa Rabu Kamis LAPANGAN
Jumat Sabtu Ahad

02 03 04 05 06 07 08

1
X
FRM/DPD/PKL/011
Paraf Pembimbing Lapang
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Periode Kegiatan (Minggu 6): 09 – 15 Maret 2020
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 8/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN


Hari / Tanggal

No. Nama Mahasiswa / NIM Senin Selasa Rabu Kamis Jumat Sabtu Ahad

09 10 11 12 13 14 15

1
DEPARTEMEN PENDIDIKAN NASIONAL
FRM/DPD/PKL/011 X
INSTITUT PERTANIAN BOGOR
Paraf Pembimbing Lapang
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 9/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN

FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 10/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

Nama Instansi
DAFTAR: KEHADIRAN
…………………………………………………….......................………………
PRAKTIK KERJA LAPANGAN
Alamat : …………………………………………………………….........……..............…
…………………………………………………….........………………..............
…………………………………………………….........………………..............

Periode Kegiatan (Minggu 7): 16 – 22 Maret 2020 FRM/DPD/PKL/011


DEPARTEMEN PENDIDIKAN NASIONAL
Hari / Tanggal
INSTITUT PERTANIAN BOGOR
No. Nama Mahasiswa / NIM
DIREKTORATSenin
PROGRAM DIPLOMA
Selasa Rabu Kamis Jumat Sabtu Ahad
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 11/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK


16 17 KERJA
18 19 LAPANGAN
20 21 22

1
X
Paraf Pembimbing Lapang
FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
Periode Kegiatan (Minggu 8): INSTITUT
23 – 29 Maret 2020
PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
No. Nama Mahasiswa / NIM Hari / Tanggal
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 12/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA


Senin Selasa Rabu Kamis LAPANGAN
Jumat Sabtu Ahad

23 24 25 26 27 28 29

1
X X
FRM/DPD/PKL/011
Paraf Pembimbing Lapang
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Periode Kegiatan (Minggu 9): 30 Maret – 05 April 2020
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 13/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN


Hari / Tanggal

No. Nama Mahasiswa / NIM Senin Selasa Rabu Kamis Jumat Sabtu Ahad

30 31 01 02 03 04 05

1
DEPARTEMEN PENDIDIKAN NASIONAL
FRM/DPD/PKL/011 X
INSTITUT PERTANIAN BOGOR
Paraf Pembimbing Lapang
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 14/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN

FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 15/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

Nama Instansi
DAFTAR: KEHADIRAN
…………………………………………………….......................………………
PRAKTIK KERJA LAPANGAN
Alamat : …………………………………………………………….........……..............…
…………………………………………………….........………………..............
…………………………………………………….........………………..............

Periode Kegiatan (Minggu 10) : 06 – 12 April 2020 FRM/DPD/PKL/011


DEPARTEMEN PENDIDIKAN NASIONAL
Hari / Tanggal
INSTITUT PERTANIAN BOGOR
No. Nama Mahasiswa / NIM
DIREKTORATSenin
PROGRAM DIPLOMA
Selasa Rabu Kamis Jumat Sabtu Ahad
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 16/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK


06 07 KERJA
08 09 LAPANGAN
10 11 12

1
X X
Paraf Pembimbing Lapang
FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
Periode Kegiatan (Minggu 11) INSTITUT
: 13 – 19 April 2020
PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
No. Nama Mahasiswa / NIM Hari / Tanggal
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 17/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA


Senin Selasa Rabu Kamis LAPANGAN
Jumat Sabtu Ahad

13 14 15 16 17 18 19

1
X
FRM/DPD/PKL/011
Paraf Pembimbing Lapang
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Periode Kegiatan (Minggu
Kampus 12) : 20
IPB – 26 April
Cilibende, Jl.2020
Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 18/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN


Hari / Tanggal

No. Nama Mahasiswa / NIM Senin Selasa Rabu Kamis Jumat Sabtu Ahad

20 21 22 23 24 25 26

1
DEPARTEMEN PENDIDIKAN NASIONAL
XFRM/DPD/PKL/011
X
INSTITUT PERTANIAN BOGOR
Paraf Pembimbing Lapang
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 19/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN

FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 20/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

Nama Instansi
DAFTAR: KEHADIRAN
…………………………………………………….......................………………
PRAKTIK KERJA LAPANGAN
Alamat : …………………………………………………………….........……..............…
…………………………………………………….........………………..............
…………………………………………………….........………………..............

Periode Kegiatan (Minggu 13) : 27 April – 03 Mei 2020 FRM/DPD/PKL/011


DEPARTEMEN PENDIDIKAN NASIONAL
Hari / Tanggal
INSTITUT PERTANIAN BOGOR
No. Nama Mahasiswa / NIM
DIREKTORATSenin
PROGRAM DIPLOMA
Selasa Rabu Kamis Jumat Sabtu Ahad
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 21/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK


27 28 KERJA
29 30 LAPANGAN
01 02 03

1
X X
Paraf Pembimbing Lapang
FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
Periode Kegiatan (Minggu 14) INSTITUT
: 04 – 10 Mei 2020
PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
No. Nama Mahasiswa / NIM Hari / Tanggal
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 22/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA


Senin Selasa Rabu Kamis LAPANGAN
Jumat Sabtu Ahad

04 05 06 07 08 09 10

1
X X
FRM/DPD/PKL/011
Paraf Pembimbing Lapang
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Periode Kegiatan (Minggu 15) : 11 – 17 Mei 2020
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 23/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN


Hari / Tanggal

No. Nama Mahasiswa / NIM Senin Selasa Rabu Kamis Jumat Sabtu Ahad

11 12 13 14 15 16 17

1
DEPARTEMEN PENDIDIKAN NASIONAL
FRM/DPD/PKL/011 X
INSTITUT PERTANIAN BOGOR
Paraf Pembimbing Lapang
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 24/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN

FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 25/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

Nama Instansi
DAFTAR: KEHADIRAN
…………………………………………………….......................………………
PRAKTIK KERJA LAPANGAN
Alamat : …………………………………………………………….........……..............…
…………………………………………………….........………………..............
…………………………………………………….........………………..............

Periode Kegiatan (Minggu 16) : 18 – 24 Mei 2020 FRM/DPD/PKL/011


DEPARTEMEN PENDIDIKAN NASIONAL
Hari / Tanggal
INSTITUT PERTANIAN BOGOR
No. Nama Mahasiswa / NIM
DIREKTORATSenin
PROGRAM DIPLOMA
Selasa Rabu Kamis Jumat Sabtu Ahad
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 26/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK


18 19 KERJA
20 21 LAPANGAN
22 23 24

1
X X
Paraf Pembimbing Lapang
FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
Periode Kegiatan (Minggu 17) INSTITUT
: 25 – 31 Mei 2020
PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
No. Nama Mahasiswa / NIM Hari / Tanggal
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 27/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA


Senin Selasa Rabu Kamis LAPANGAN
Jumat Sabtu Ahad

25 26 27 28 29 30 31

1
X
FRM/DPD/PKL/011
Paraf Pembimbing Lapang
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Periode Kegiatan (Minggu 18) : 01 – 07 Juni 2020
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 28/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN


Hari / Tanggal

No. Nama Mahasiswa / NIM Senin Selasa Rabu Kamis Jumat Sabtu Ahad

01 02 03 04 05 06 07

1
DEPARTEMEN PENDIDIKAN NASIONAL
X FRM/DPD/PKL/011 X
INSTITUT PERTANIAN BOGOR
Paraf Pembimbing Lapang
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 29/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN

FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 30/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

Nama Instansi
DAFTAR: KEHADIRAN
…………………………………………………….......................………………
PRAKTIK KERJA LAPANGAN
Alamat : …………………………………………………………….........……..............…
…………………………………………………….........………………..............
…………………………………………………….........………………..............

Periode Kegiatan (Minggu 19) : 08 – 14 Juni 2020 FRM/DPD/PKL/011


DEPARTEMEN PENDIDIKAN NASIONAL
Hari / Tanggal
INSTITUT PERTANIAN BOGOR
No. Nama Mahasiswa / NIM
DIREKTORATSenin
PROGRAM DIPLOMA
Selasa Rabu Kamis Jumat Sabtu Ahad
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 31/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK


08 09 KERJA
10 11 LAPANGAN
12 13 14

1
X
Paraf Pembimbing Lapang
FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
Periode Kegiatan (Minggu 20) INSTITUT
: 15 – 21 Juni 2020
PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
No. Nama Mahasiswa / NIM Hari / Tanggal
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 32/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

DAFTAR KEHADIRAN PRAKTIK KERJA


Senin Selasa Rabu Kamis LAPANGAN
Jumat Sabtu Ahad

10 11 12 13 14 15 16

1
X
FRM/DPD/PKL/011
Paraf Pembimbing Lapang
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
______________, _____________________
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Mengetahui,
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 33/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

Pembimbing Lapang
DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN

________________________________
(Nama Jelas, Tanda tanganFRM/DPD/PKL/011
dan Stempel)
DEPARTEMEN PENDIDIKAN NASIONAL
Catatan : INSTITUT PERTANIAN BOGOR
- Daftar Kehadiran PKL dapat diperbanyakPROGRAM
DIREKTORAT sesuai denganDIPLOMA
waktu PKL
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 34/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)
Keterangan
*) Dikumpulkan paling lambat Tgl ................... FRM/DPD/PKL/008
**) Urutan berdasarkan prioritas
KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN
INSTITUT PERTANIAN BOGOR
SEKOLAH VOKASI
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101

- Daftar Kehadiran PKL diserahkan ke Program Studi maksimal satu minggu setelah PKL
DAFTAR KEHADIRAN PRAKTIK KERJA LAPANGAN
berakhir

FRM/DPD/PKL/011
DEPARTEMEN PENDIDIKAN NASIONAL
INSTITUT PERTANIAN BOGOR
DIREKTORAT PROGRAM DIPLOMA
Kampus IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 35/7 Tanggal Berlaku : 1 Februari 2010
PEMILIHAN MINAT BIDANG KAJIAN PKL*)
PROGRAM KEAHLIAN …………………………………..
TAHUN AKADEMIK 20.../20...

Nama : ............................................................
NIM : ........................

Usulan Minat Bidang Kajian**) :


1. .......................................................
2. .......................................................
3. .......................................................

Usulan Lokasi PKL :


Nama Perusahaan/Instansi : ...............................................................................
...............................................................................

Alamat Lengkap : ...............................................................................


...............................................................................
...............................................................................
Nama Pimpinan Perusahaan/Instansi : ...............................................................................

Contact Person/Telepon/HP/E-mail : ...............................................................................


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

Bogor, ____________________
Mahasiswa,

(__________________________)