Nama : ............................................................................................. Jabatan : .................................................................................. ........... Instansi : .............................................................................................. ............................................................................................. ............................................................................................. Alamat Lembaga : .............................................................................................. .............................................................................................. .............................................................................................. Telp. : .............................................................................................. Fax. : .............................................................................................. E-mail : ..............................................................................................
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Nama : …………………………………………………………… Peran/Jabatan : …………………………………………………………… Instansi : ……………………………………………………………. B. Informasi Umum 1. Berapa lama Saudara telah mengenal Pendaftar? .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... 2. Dalam kapasitas apa Saudara berinteraksi dengan Pendaftar? .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... ....................................................................................................................................
3. Apa kekuatan atau kompetensi pendaftar yang menurut Anda dapat
menunjang perannya sebagai narasumber materi fasilitasi pada kegiatan Program Sekolah Penggerak ? (Anda dapat menuliskan 1 sampai dengan 6 kekuatan atau kompetensi yang dimiliki Pendaftar) .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... 4. Pada saat pendaftar mendapat tanggung jawab dalam lingkungan pekerjaan, menurut pengamatan Saudara, bagaimana pendaftar berkomitmen menyelesaikan tanggung jawab tersebut? .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... .................................................................................................................................... Apakah Anda merekomendasikan kandidat sebagai narasumber fasilitasi? (ceklis pada pilihan di bawah ini) ● Merekomendasikan ● Kurang merekomendasikan ● Tidak merekomendasikan