Tahun Pelajaran
Kelas / No. Absen VII - ...... / ........ VIII - ...... / ........ IX - ...... / ........
ANAK BELAJAR DARI KEHIDUPANNYA
1
KATA PENGANTAR
Syukur Alhamdulillah ke Hadirat Illahi Robbi, kami Guru BK SMP Negeri I Prambon telah
dapat menyelesaikan penyusunan buku Aplikasi Instrumentasi dan Himpunan Data.
Buku ini merupakan salah satu alat untuk mengumpulkan data tentang keadaan ananda
dan orang tua. Informasi yang lengkap dan tepat tentang keadaan ananda dan orang tua akan
sangat membantu kami dalam rangka pelayanan bimbingan dan konseling. Oleh karena itu
instrumen ini mohon diisi dengan data yang sebenarnya.
Instrumen ini mohon diisi dengan jelas sesuai dengan keadaan ananda. Jika dalam proses
pengisian ada hal-hal yang belum ananda ketahui, misalnya pangkat dan golongan pada
pekerjaan orang tua ananda, dapat menanyakan pada orang tua ananda masing-masing.
Sedangkan hal-hal khusus yang tidak tercantum dalam angket ini, dapat ananda tambahkan pada
halaman lain-lain/tambahan yang ada pada bagian belakang angket ini.
KATA PENGANTAR
DAFTAR ISI
IDENTITAS SISWA
A. Keterangan Tempat Tinggal
B. Keterangan Orang Tua / Wali
C. Keterangan saudara Lain
D. Keterangan Pendidikan
E. Keterangan Kesehatan
F. Harapan dan Cita-cita
G. Hobby dan Kegemaran
H. Kegiatan Belajar Sehari-hari
I. Keterangan Potensi
J. Keterangan lain-lain / Tambahan
Konseling Individu
Konseling dan Bimbingan Kelompok
Catatan Anekdot
INSTRUMEN DAN HIMPUNAN DATA
BIMBINGAN DAN KONSELING
SMP NEGERI I SIDOARJO
Ds.......................................................................................
FOTO
3X4
No Telp ; ...........................................................................................
1.
2.
3.
4.
5.
50. Saudara tiri ............. orang, yaitu :
1.
2.
3.
D. KETERANGAN PENDIDIKAN.
51. Asal Sekolah Dasar ( SD ) : ................................................................................
52. Lama belajar di SD :
1. < 6 th
2. 6 th
3. > 6 th
1. Bahasa Indonesia
2. Matematika
3. IPA
JUMLAH
2. Agama
3. Bahasa Indonesia
4. Matematika
5. IPA
6. IPS
9. Muatan Lokal :
a.
b.
c.
d.
JUMLAH
59. Organisasi / Perkumpulan yang pernah diikuti dalam bidang olah raga
1. Atletik
2. Ketangkasan
3. Bela diri
4. Lain-lain ( .....................................................)
60. Organisasi/perkumpulan yang pernah diikuti dalam bidang kesenian :
1. Seni suara
2. Seni rupa
3. Seni pahat/patung
4. Seni tari/drama
5. Lain-lain ( ....................................................)
61. Organisasi/perkumpulan yang pernah diikuti dalam bidang lain-lain :
1. Pramuka
2. OSIS
3. Lain-lain (.....................................................)
62. Prestasi Belajar di SMP
a. Kelas VII
N MATA PELAJARAN KETRAMPILAN (K1 4)
PENGETAHUAN (K1 3)
O
1. PABP
2. PPKN
3. Bahasa Indonesia
4. Matematika
5. IPA
6. IPS
7. Bahasa Inggris
Kelompok B
1. Seni Budaya
2. PJOK
3. Prakarya
4. Bahasa Sunda
b. Kelas VIII
N MATA PELAJARAN KETRAMPILAN (K1 4)
PENGETAHUAN (K1 3)
O
1. PABP
2. PP KN
3. Bahasa Indonesia
4. Matematika
5. IPA
6. IPS
7. Bahasa Inggris
Kelompok B
1. Seni Budaya
2. PJOK
3. Prakarya
4. Bahasa Sunda
c. Kelas IX
N MATA PELAJARAN KETRAMPILAN (K1 4)
PENGETAHUAN (K1 3)
O
1. PABP
2. PPKN
3. Bahasa Indonesia
4. Matematika
5. IPA
6. IPS
7. Bahasa Inggris
Kelompok B
1. Seni Budaya
2. PJOK
3. Prakarya
4. Bahasa Sunda
E. KETERANGAN KESEHATAN
63. Berat badan : ...................................................................
64. Tinggi badan : ...................................................................
65. Golongan darah : ...................................................................
66. Keadaan mata : 1. Normal.
2. Rabun jauh.
3. Rabun dekat.
4. Kelainan mata lainnya (.........................)
1. Pembentukan keputusan
2. Penghayatan Bahasa
3. Fleksibilitas Berfikir
4. Abstraksi
5. Mengingat
6. Berhitung
7. Analisa Sintesa
8. Tiga Dimensi
KEPRIBADIAN UMUM
1. Sosialisasi
3. Sikap Kejujuran
KECERDASAN EMOSIONAL
4. Menggunakan emosi
KECERDASAN MAJEMUK
1. Linguistik
2. Musikal
3. Matematika – Logika
4. Visual – Spasial
5. Kinestetik
6. Sosial
7. Personal
8 Natural – Estetika
9. Spiritual
111. Bakat.
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112. Minat.
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J. KETERANGAN LAIN-LAIN / TAMBAHAN
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KONSELING INDIVIDU
NO. TANGGAL DISKRIPSI MASALAH TINDAK LANJUT
BIMBINGAN / KONSELING KELOMPOK
NO. TANGGAL DISKRIPSI MASALAH TINDAK LANJUT
CATATAN ANEKDOT
NO. TANGGAL DISKRIPSI MASALAH TINDAK LANJUT