PPPPTK MATEMATIKA YOGYAKARTA

Kode Dok : F-EVA-019

Revisi No : 2
RENCANA PROGRAM TINDAK LANJUT PASCA DIKLAT
PPPPTK MATEMATIKA
Nama Diklat : ...........................................................................................................................................................
Tanggal Diklat : ...........................................................................................................................................................................
Nama Peserta : ...........................................................................................................................................................................
No. HP : ...........................................................................................................................................................................
Instansi : ...........................................................................................................................................................................
Alamat : ...........................................................................................................................................................

Tahun 2021 2022

No. Kegiatan Tujuan Sasaran Pelaksanaan Bulan Ke
5 6 7 8 9 10 11 12 1 2
1
2
3
4
5
6
7
8
9
10

*) Tahun/Bulan bisa dirubah sesuai kebutuhan Yogyakarta, .....................

Penyusun,
 Tahun 2021 2022
No. Kegiatan Tujuan Sasaran Pelaksanaan Bulan Ke
5 6 7 8 9 10 11 12 1 2

…………………………………………………
NIP. …………………………………………
 PPPPTK MATEMATIKA YOGYAKARTA
Kode Dok : F-EVA-020
Revisi No : 2
LAPORAN KETERLAKSANAAN IMPLEMENTASI PROGRAM TINDAK LANJUT PASCA DIKLAT
PPPPTK MATEMATIKA
Nama Diklat : ...........................................................................................................................................................
Tanggal Diklat : ...........................................................................................................................................................:
Nama Peserta : ...........................................................................................................................................................
No. HP : ..............................................................................................................................................
Instansi : ...........................................................................................................................................................:
Alamat : ...........................................................................................................................................................

No. Kegiatan Tujuan Sasaran Waktu Kendala Solusi

1 Siapa
2 Jumlahnya berapa
3
4
5
6
7
8
9
10

Mengetahui ……………………………………………….
Kepala Seksi Evaluasi Penyusun,

............................................................... …………………………………………………
NIP............................................................. NIP. …………………………………………

Catatan:
1. Laporan Keterlaksanaan Implementasi PTL Pasca Diklat dilampiri dengan foto-foto kegiatan, daftar hadir pesertaimplementasi dan dikirim melalui:
a. via email dg alamat : evaluasip4tkmat@gmail atau
b. Ke seksi evaluasi dg alamat PPPPTK Matematika, Jl, Kaliurang Km. 6 Yogyakarta
2. Laporan Pelaksanaan Implementasi PTL Pasca Diklat Diketaui/Disyahkan oleh Kepala Sekolah atau Ketua MGMP Tempat Pelaksanaan Implementasi
No. Kegiatan Tujuan Sasaran Waktu Kendala Solusi