INSTRUMEN PENGUMPULAN DATA

KULIAH KERJA LAPANGAN (KKL)

DI MADRASAH/SEKOLAH

A. IDENTITAS MADRASAH/SEKOLAH
1 Nama Madrasah/Sekolah : ……………………………………...
2 NPSN : ………………………………………
3 Alamat : ………………………………………
4 Nomor Telp. : ………………………………………
5 StatusMadrasah/Sekolah : ………………………………………
6 Nama Yayasan (jika swasta) : ………………………………………
7 Akreditasi Madrasah/Sekolah : ………………………………………
8 Kepala Madrasah/Sekolah : ………………………………………

B. PROFIL MADRASAH/SEKOLAH
1. Visi Madrasah/Sekolah:
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2. Misi Madrasah/Sekolah:
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3. Tujuan Madrasah/Sekolah:
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4. Sejarah Perkembangan Madrasah/Sekolah:
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5. Prestasi Madrasah/Sekolah
No Jenis Prestasi Tingkat Kejuaraan (Lokal, Tahun
Perlombaan yang Kab, Prov, Nasional,
Diperolah Internasional)
1
2
C. KURIKULUM
1. Kurikulum
a. Kurikulum yang Digunakan Saat Ini:
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b. Program Unggulan Madrasah/Sekolah
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c. Ekstra Kurikuler
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2. Pembelajaran
a. Masuk: …………… Pulang: ……………
b. Kegiatan Pembiasaan Pembelajaran:
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c. Metode Pembelajaran:
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d. Sistem Evaluasi Belajar

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e. Pelajaran Tambahan
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D. KEADAAN SISWA
1. Awal Tahun Ajaran 2020 / 2021
Siswa Pendaftar Siswa yang diterima Siswa Daftar Ulang
L P Jumlah L P Jumlah L P Jumlah
2. Jumlah Siswa
Kelas L P Jumlah

3. Kuota Penerimaan Siswa Baru Tahun Ajaran 2021/2022: ........ Siswa

4. Jumlah Kelulusan Siswa Tahun 2020 /2021

L P Jumlah

5. Prestasi Siswa

No Jenis Prestasi Tingkat Kejuaraan (Lokal, Tahun

Perlombaan Yang Kab, Prov, Nasional,
Diperolah Internasional)
1
2
3
4
5
6
7

E. KETENAGAAN
1. Jumlah Tenaga Pendidik/Guru

Jenis Kelamin PNS Tetap Yayasan Tidak Tetap

L
P
Jumlah

2. Pendidikan Terakhir Tenaga Pendidik/Guru

Jenis SLTA Diploma/Sarmud S1 S2 S3 Jumlah

Kelamin Kebawah
L
P
Jumlah
 3. Jumlah Tenaga Kependidikan/Pegawai

Jenis SLTA Diploma/Sarmud S1 S2 S3 Jumlah

Kelamin Kebawah
L
P
Jumlah

4. Prestasi Pendidik/Tenaga Kependidikan

No Jenis Prestasi Tingkat Kejuaraan (Lokal, Tahun

Perlombaan Yang Kab, Prov, Nasional,
Diperolah Internasional)
1
2
3
4
5
6
7

F. SUMBER PEMBIAYAAN

No Sumber Ya Tidak
1 Pemerintah
2 Orang Tua/Wali Siswa
3 Masyarakat
4 Usaha Sekolah
5 Lainnya (Sebutkan ……)

G. SARANA PRASARANA SEKOLAH

No Jenis Ketersediaan
Ada Tidak
1 Ruang Kepala Sekolah
2 Ruang Guru
3 Ruang Tata Usaha
4 Perpustakaan
5 Laboratorium
6 UKS
7 dll
H. PERMASALAHAN-PERMASALAHAN DI MADRASAH/SEKOLAH
UNTUK DIJADIKAN BAHAN PENELITIAN
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