LAPORAN KUNJUNGAN RUMAH (HOME VISIT)

SMKN 1 MALAUSMA

1. Identitas Siswa
Nama : ..................................................................................
Kelas/NIS/NISN : ..................................................................................
Jenis Kelamin : ..................................................................................
Alamat : ..................................................................................
Nama Orang tua : ..................................................................................
No HP Orang tua/pihak yang relevan : ..................................................................................
2. Permasalahan
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3. Tujuan
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4. Pelaksanaan
Hari, tanggal : ..................................................................................................
Yang ditemui : ..................................................................................................
5. Hasil Kunjungan
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6. Tindak Lanjut
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Wali Kelas Orang tua/Wali Siswa

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ARSADI, S.Pd. MM
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Lembar ini supaya disertakan dalam Laporan Bulanan Wali Kelas