LAPORAN PENGEMBANGAN DIRI

............................................................................................
............................................................................................
( NAMA DIKLAT)
..

Hari / Tanggal : ............................................................................

Tempat : ........................................................................................
.....................................................................................................

OLEH:

Nama : ..............................................
NIP. : ..............................................
Unit kerja : ..............................................

SD/SMP ......................................
.............................................
.................................
 PENGESAHAN

LAPORAN PENGEMBANGAN DIRI

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

................................................................................................................
(NAMA DIKLAT)

Hari / Tanggal : ............................................................................

Tempat : ........................................................................................
.....................................................................................................

Oleh :

Nama : ..............................................
NIP. : ..............................................
Unit kerja : ..............................................

Disahkan oleh :

Kepala ..............................................

..............................................
NIP.
 IDENTITAS PESERTA

1. Nama Guru : .....................................................................

2. NIP : .....................................................................

3. NUPTK/NRG : .....................................................................

4. SertifikatPendidik : .....................................................................

5. Jabatan/Golongan Guru : .....................................................................

6. Alamat Sekolah : : .....................................................................

 Jalan : .....................................................................

 Kabupaten, Provinsi : ..................................................................... ...

 Provinsi : ..................................................................

7. Mengajar Mata Pelajaran : .....................................................................

8. Alamat Rumah: :

 Jalan : .....................................................................

: .....................................................................

 Kabupaten, Provinsi : .....................................................................

 HP : .....................................................................

 E-mail : .....................................................................
1. Bagian awal
a. Nama Kegiatan
............................................................................................................................................................
b. Waktu pelaksanaan
Hari / tanggal : .....................................................................................................................................
c. Tempat kegiatan
.............................................................................................................................................
d. Tujuan kegiatan
1) .....................................................................................................................................
2) ......................................................................................................................................
3) .....................................................................................................................................
e. Lama diklat
Selama ..... hari, pola ........jam
f. Surat tugas Kepala Sekolah
Nomor : ................................................................... tanggal ........................................
Surat tugas terlampir.
g. Sertifikat kegiatan Bimtek
No. ..................................................................
Sertifikat kegiatan terlampir.

2. Bagian isi
a. Tujuan diklat
Kegiatan bimtek ini bertujuan untuk :
1) .....................................................................................................................................
2) ......................................................................................................................................
3) .....................................................................................................................................
b. Materi diklat
1) .....................................................................................................................................
2) ......................................................................................................................................
3) .....................................................................................................................................
4) .....................................................................................................................................
5) ......................................................................................................................................
6) .....................................................................................................................................
7) .....................................................................................................................................
8) .....................................................................................................................................
9) .......................................................................................................................................
10) .....................................................................................................................................
c. Tindak lanjut
1) .....................................................................................................................................
2) ......................................................................................................................................
3) .....................................................................................................................................
4) .....................................................................................................................................
d. Dampak
1) .....................................................................................................................................
2) ......................................................................................................................................
3) .....................................................................................................................................
4) .....................................................................................................................................
e. Penutup
Terima kasih kepada semua pihak yang telah memberikan bantuan dalam kegiatan diklat ini
Semoga diklat ini dapat bermanfaat bagi peserta dan rekan guru yang lain.
3. Bagian akhir
Matrik kegiatan

Jumlah Jam Dampak*)

Tempat Nama Penyelenggara
No Nama Diklat Kegiatan Nama Fasilitator
Kegiatan Kegiatan
Diklat
1 ..... JP

Klaten, ...............................
Peserta kegiatan

..............................................
NIP. .....................................
 RANGKUMAN MATERI

..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
.......... dst