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PEMERINTAH DAERAH PROVINSI JAWA BARAT

DINAS PENDIDIKAN
CABANG DINAS PENDIDIKAN WILAYAH XII
Jalan Sutisna Senjaya No 231 Cikalang Kec. Tawang Kota Tasikmalaya
E-Mail: cadisdikwil12@gmail.com

INSTRUMEN MONITORING ASESMEN NASIONAL JENJANG SMA/SMK


TAHUN 2022

Nama Sekolah : .........................


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

1. Peserta

Jumlah Peserta
Jumlah Peserta Jumlah Peserta Hadir
No Tidak Hadir
Lk Pr Total Lk Pr Total Lk Pr Total

1.

2. Kendala yang dihadapi


a. .............................................................
b. .............................................................
c. .............................................................
d. .............................................................

3. Catatan
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................
.......................................................................................................................................

Tasikmalaya, ....................2022
Kepala Sekolah, Petugas Monitoring/ Pengawas
SMK

............................................. MAMAN, S. Pd., MBA.


NIP NIP 196709191991031006

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