DINAS PENDIDIKAN KABUPATEN KUTAI BARAT

BERITA ACARA
PENYELENGGARAN UJIAN SEKOLAH (US)
TAHUN PELAJARAN 2018 / 2019

Pada hari ini ............. Tanggal ................................ Bulan ............... Tahun Dua Ribu Sembilan Belas

A. Telah diselenggarakan Ujian Sekolah (US) dari pukul ........................... sampai ........................

Pada Sekolah : ........................................................................................................

Alamat : ........................................................................................................
Ruangan : ........................................................................................................
Jumlah Peserta : ........................................................................................................
Seharusnya : ........................................................................................................
Yang Hadir : ........................................................................................................
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Yang Tidak Hadir : .........................................................................................................
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B. Sampul / Amplop Ujian Sekolah (US) ...........................................*) Telah dibuka di ruang
Ujian Sekolah (US) dengan disaksikan peserta, soal US sebanyak ............................ eksempar
Berita acara sebanyak ......................... ekslempar dan daftar hadir sebanyak ........... eksempar

Sebelum dibuka sampul / amplop Ujian Sekolah (US) tersebut dalam keadaan baik.

C. Catatan selama pelaksanaan Ujian Sekolah (US).

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Berita Acara ini dibuat dengan sesungguhnya.

Yang Membuat Berita Acara

Pengawas I, Pengawas II,

Tanda Tangan ...................................................... Tanda Tangan ...............................................

Nama ...................................................... Nama ...............................................

NIP. ...................................................... NIP. ..............................................