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FRM/DPD/PKL/010

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

LAPORAN PERIODIK
PRAKTIK KERJA LAPANGAN DAN TUGAS AKHIR
Periode Laporan : ……………………………..……………………………..
………
Nama Mahasiswa / NIM : ……………………………..…………………………….. FRM/DPD/PKL/011
……… DEPARTEMEN PENDIDIKAN NASIONAL
Program Keahlian : INSTITUT
EkowisataPERTANIAN BOGOR
Nama Instansi DIREKTORAT PROGRAM DIPLOMA
: ……………………………………………………………………
Alamat Kampus :IPB Cilibende, Jl. Kumbang No.14 Bogor 16151
……………………………………………………………………
Telp. (0251) 8329101, 8329051, Fax (0251) 8329101
No. Revisi : 01 Hal: 1/1 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 ...................
**) Urutan berdasarkan prioritas FRM/DPD/PKL/010
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

Periode Kegiatan : Minggu ......... (...................................................... 2020)

Tanggal Informasi yang diperoleh Masalah/Kendala

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: 1/1 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 ...................
**) Urutan berdasarkan prioritas FRM/DPD/PKL/010
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

PKL

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: 1/1 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 ...................
**) Urutan berdasarkan prioritas FRM/DPD/PKL/010
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

TA

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: 1/1 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 ...................
**) Urutan berdasarkan prioritas FRM/DPD/PKL/010
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

Catatan Khusus
......................................................................................................................................... ..............
......................................................................................................................................... ..............
______________, _____________________
Mengetahui,
Pembimbing Lapang
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: 1/1 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 ...................
**) Urutan berdasarkan prioritas FRM/DPD/PKL/010
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 Jelas, Tanda tangan dan Stempel)

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: 1/1 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,

(__________________________)