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    YAYASAN ANUGRAH BHAKTI INSANI

    SMK KESEHATAN SURYA GLOBAL CIMAHI


    Jalan Pendidikan I No 112A RT 09/RW09 Kihapit Barat Leuwigajah Cimahi Selatan
    telp (021) 86692355 Email : smksuryaglobal@yahoo.com
    Website: www.smksuryaglobal.sch.id

    LAPORAN KUNJUNGAN RUMAH


    (HOME VISIT)

    NOMOR : .................... KELAS/PROGRAM:...................

    I IDENTITAS : ...........................................................................................
    1. Nama Lengkap Siswa : ...........................................................................................
    2. Nama Orang Tua/Wali : ...........................................................................................
    3. Pekerjaan Orang Tua/Wali : ...........................................................................................
    4. Alamat Lengkap Dan No. Tlp : ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    II MAKSUD DAN TUJUAN : ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    III HASIL WAWANCARA : ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    IV KESIMPULAN : ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................
    ...........................................................................................

    Orang Tua / Wali Siswa Cimahi, .........................


    Wali Kelas

    ....................................
    .....................................
    NIP...............................
    Mengetahui Guru BP/BK

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

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