NAMA GURU :
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PROPINSI : ............................................................................
Tinggi badan
Berat Badan
Jumlah Sdr
Anak Ke
Agama
No. Tempat Penyakit yang Pernah
L/P
No. NISN Nama Siswa
Induk Dan Tgl. Lahir diderita
1 2 3 4 5 6 7 8 9 10 11 12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
Ayah Ibu
Nama Umur Pendidikan Pekerjaan Nama Umur Pendidikan Pekerjaan
13 14 15 16 17 18 19 20
Sakit
L/P
Induk
alpa
Izin
2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
(S) Sakit
(I) Izin
(A) Alpa
Jumlah
S+I+A
=
Absensi : Izin (I) X 100 %
=
Sakit (S) X 100 %
=
Alpa (A) X 100 %
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NIP. 19660405 198809 2 001 NIP.
alpa
Izin
2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
L
/
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
(S) Sakit
(I) Izin
(A) Alpa
Jumlah
S+I+A
=
Absensi : Izin (I) X 100 %
=
Sakit (S) X 100 %
=
Alpa (A) X 100 %
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NIP. 19660405 198809 2 001 NIP.
Jumlah
BULAN Jumlah Jumlah Jumlah JUMLAH MENURUT UMUR
Murid
Murid 15
Murid Murid 6 7 8 9 10 11 12 13 14
awal Masuk Thn ke
Keluar Akhir bulan thn thn thn thn thn thn thn thn thn
bulan atas
1. Juli L P L P L P L P L/P L/P L/P L/P L/P L/P L/P L/P L/P L/P
2. Agustus
3. September
4. Oktober
5. November
6. Desember
7. Januari
8. Februari
9. Maret
10. April
11. Mei
12. Juni
JUMLAH
............................, ....................................20
Mengetahui,
Kepala MIN.............................. Guru Kelas
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NIP. 19660405 198809 2 001 NIP. ...............................................