PEMERINTAH PROVINSI JAMBI

DINAS PENDIDIKAN
SMK SATRIA PUTRA BANGSA KOTA JAMBI
NPSN : 69931972 Email : smkpaba.jambi@gmail.com
Jl. Sunan Gunung Jati RT. 40 Kel. Kenali Asam Bawah Kota Jambi - Kode Pos 36128

SURAT TUGAS HOME VISIT

Nomor…...../420-SMK-PB/XI/2021

Kepala SMK Satria Putra Bangsa Kota Jambi Kec. Kota Baru, Dengan ini Memberikan Tugas
kepada :

Nama : ................................................................................................

Jabatan : ................................................................................................

Untuk melaksanakan HOME VISIT (Kunjungan Rumah) Kepada siswa yang tercantum
di bawah ini :

Nama : ................................................................................................

Kelas : ................................................................................................

Alamat : ................................................................................................

      
Dalam Rangka memberikan Bimbingan dan penyuluhan Kepada siswa tersebut di atas
Beserta pihak orang tua/keluarganya.

Jambi, ….., ………….. ………2021

Mengetahui, Kepala
Wali Murid

Dra.HJ. Rusiani, M.Pd

……………………………………………….. Nip: 19660302 198903 2 015
 PEMERINTAH PROVINSI JAMBI
DINAS PENDIDIKAN
SMK SATRIA PUTRA BANGSA KOTA JAMBI
NPSN : 69931972 Email : smkpaba.jambi@gmail.com
Jl. Sunan Gunung Jati RT. 40 Kel. Kenali Asam Bawah Kota Jambi - Kode Pos 36128

LAPORAN HOME VISIT

Berdasarkan hasil HOME VISIT (Kunjungan Rumah ) Terhadap siswa di bawah ini :

Nama : ..............................................................................................................

Kelas        : ..............................................................................................................

Alamat  : ..............................................................................................................

Hasil kunjungan sebagai berikut :

1. ......................................................................................................................................

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

2. ......................................................................................................................................

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

3. ......................................................................................................................................

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

4. ......................................................................................................................................

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

5. ......................................................................................................................................

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

Siliwangi,…, ………………., 2021

Mengetahui,
Kepala                                                                     Petugas Home Visit

Dra. Hj. Rusiani, M.Pd ………………….…………………

Nip :19660302 198903 2 015