BUKU LAPORAN

HASIL BELAJAR PESERTA DIDIK

TAMAN KANAK-KANAK
( TK )

Nama TK : ......................................................................
NSTK / NPSN : ......................................................................
Alamat : ......................................................................
......................................................................
Kelurahan : ......................................................................
Kecamatan : ......................................................................
Kota : SURABAYA
Propinsi : JAWA TIMUR

Nama Peserta Didik

...........................................................................................

Nomor Induk : ..........................................................................

DINAS PENDIDIKAN
KOTA SURABAYA
 CATATAN KHUSUS

Kelompok : ............................... Kelompok : ...............................

Semester I Semester I

BUKU LAPORAN
HASIL BELAJAR PESERTA DIDIK
TAMAN KANAK-KANAK
( TK )

Semester II Semester II
Nama TK : ......................................................................
NSTK / NPSN : ......................................................................
Alamat : ......................................................................
......................................................................
Kelurahan : ......................................................................
Kecamatan : ......................................................................
Kota : SURABAYA
Catatan Catatan
Propinsi : JAWA TIMUR

Nama Peserta Didik

...........................................................................................

Nomor Induk : ..........................................................................

DINAS PENDIDIKAN
KOTA SURABAYA
16
 PETUNJUK PENGGUNAAN BELAJAR PESERTA DIDIK

Kelompok :
Semester :
1. Buku Laporan Penilaian Perkembangan Peserta Didik TK ini dipergunakan selama peserta Tahun Pelajaran :
didik mengikuti pendidikan TK.
PROJEK PENGUATAN PROFIL PELAJAR PANCASILA
2. Buku Laporan Penilaian Perkembangan Peserta Didik TK ini diisi oleh guru kelas.
..........................................................................................................................................................
3. Buku Laporan Penilaian Perkembangan Peserta Didik TK ini dilengkapi dengan pas foto hitam
putih ukuran 3 x 4 cm.

4. Penilaian tersebut diatas, dilakukan dengan menggunakan teknik-teknik penilaian yang ..........................................................................................................................................................
berlaku di Taman Kanak-kanak secara terus-menerus.
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Pertumbuhan Keterangan
Berat Badan : ...............................Kg Sakit : ............................ Hari
Tinggi Badan : ...............................Cm Izin : ............................ Hari
Alpa : ............................ Hari

Diberikan di : ...........................................
Pada tanggal : ...........................................
Mengetahui
Kepala TK Guru Wali

............................................... ...............................................

REFLEKSI ORANG TUA

..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
Surabaya,
Orang Tua

...............................................

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15
 LAPORAN HASIL KETERANGAN DIRI PESERTA DIDIK
Nama Peserta Didik :
Nomor Induk :
Nama TK : 1. Nama Peserta Didik : ..........................................................................................
a. Nama Lengkap : ..........................................................................................
NILAI AGAMA DAN BUDI PEKERTI b. Nama Panggilan : ..........................................................................................
.......................................................................................................................................................... 2. Nomor Induk : ..........................................................................................
3. Jenis Kelamin : Laki-laki/Perempuan *)
4. Tempat dan Tanggal Lahir : ..........................................................................................
5. Agama : ..........................................................................................
..........................................................................................................................................................
.......................................................................................................................................................... 6. Anak ke ..........................................................................................
.......................................................................................................................................................... 7. Nama Orang Tua / Wali *) : ..........................................................................................
.......................................................................................................................................................... 8. Pekerjaan Orang Tua / Wali *)
a. A y a h : ..........................................................................................

JATI DIRI b. I b u : ..........................................................................................

9. Alamat Orang Tua / Wali *)
.......................................................................................................................................................... a. Jalan
b. Kelurahan
.......................................................................................................................................................... c. Kecamatan
.......................................................................................................................................................... d. Kota
..........................................................................................................................................................
e. Propinsi
..........................................................................................................................................................
: ..........................................................................................
Telepon ............................................................................
: ..........................................................................................
: ..........................................................................................
: SURABAYA
: JAWA TIMUR

Dasar-dasar Literasi, Matematika, Sains, Teknologi, Rekayasa Dan Seni

.......................................................................................................................................................... ................................., ..............................................
Kepala Taman Kanak-kanak

.......................................................................................................................................................... Foto
.......................................................................................................................................................... 3 x 4 cm
..........................................................................................................................................................
..........................................................................................................................................................
.......................................................................................................................................................... NIP. ..............................................
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 LAPORAN HASIL BELAJAR PESERTA DIDIK

Nama Peserta Didik : Kelompok :

Nomor Induk : Semester :
Nama TK : Tahun Pelajaran :

NILAI AGAMA DAN BUDI PEKERTI PROJEK PENGUATAN PROFIL PELAJAR PANCASILA
.......................................................................................................................................................... ..........................................................................................................................................................

.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
JATI DIRI
.......................................................................................................................................................... Pertumbuhan Keterangan
Berat Badan : ...............................Kg Sakit : ............................ Hari
Tinggi Badan : ...............................Cm Izin : ............................ Hari
Alpa : ............................ Hari
..........................................................................................................................................................
..........................................................................................................................................................
.......................................................................................................................................................... Diberikan di : ...........................................
.......................................................................................................................................................... Pada tanggal : ...........................................
Mengetahui
Dasar-dasar Literasi, Matematika, Sains, Teknologi, Rekayasa Dan Seni Kepala TK Guru Wali

..........................................................................................................................................................

............................................... ...............................................
..........................................................................................................................................................
REFLEKSI ORANG TUA
..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... Surabaya,
.......................................................................................................................................................... Orang Tua
..........................................................................................................................................................
..........................................................................................................................................................
...............................................

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 LAPORAN HASIL BELAJAR PESERTA DIDIK

Nama Peserta Didik : Kelompok :

Nomor Induk : Semester :
Nama TK : Tahun Pelajaran :

NILAI AGAMA DAN BUDI PEKERTI PROJEK PENGUATAN PROFIL PELAJAR PANCASILA
.......................................................................................................................................................... ..........................................................................................................................................................

.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
JATI DIRI
.......................................................................................................................................................... Pertumbuhan Keterangan
Berat Badan : ...............................Kg Sakit : ............................ Hari
Tinggi Badan : ...............................Cm Izin : ............................ Hari
Alpa : ............................ Hari
..........................................................................................................................................................
..........................................................................................................................................................
.......................................................................................................................................................... Diberikan di : ...........................................
.......................................................................................................................................................... Pada tanggal : ...........................................
Mengetahui
Dasar-dasar Literasi, Matematika, Sains, Teknologi, Rekayasa Dan Seni Kepala TK Guru Wali

..........................................................................................................................................................

............................................... ...............................................
..........................................................................................................................................................
REFLEKSI ORANG TUA
..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... Surabaya,
.......................................................................................................................................................... Orang Tua
..........................................................................................................................................................
..........................................................................................................................................................
...............................................

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 LAPORAN HASIL BELAJAR PESERTA DIDIK

Nama Peserta Didik : Kelompok :

Nomor Induk : Semester :
Nama TK : Tahun Pelajaran :

NILAI AGAMA DAN BUDI PEKERTI PROJEK PENGUATAN PROFIL PELAJAR PANCASILA
.......................................................................................................................................................... ..........................................................................................................................................................

.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
JATI DIRI
.......................................................................................................................................................... Pertumbuhan Keterangan
Berat Badan : ...............................Kg Sakit : ............................ Hari
Tinggi Badan : ...............................Cm Izin : ............................ Hari
Alpa : ............................ Hari
..........................................................................................................................................................
..........................................................................................................................................................
.......................................................................................................................................................... Diberikan di : ...........................................
.......................................................................................................................................................... Pada tanggal : ...........................................
Mengetahui
Dasar-dasar Literasi, Matematika, Sains, Teknologi, Rekayasa Dan Seni Kepala TK Guru Wali

..........................................................................................................................................................

............................................... ...............................................
..........................................................................................................................................................
REFLEKSI ORANG TUA
..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... Surabaya,
.......................................................................................................................................................... Orang Tua
..........................................................................................................................................................
..........................................................................................................................................................
...............................................

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 LAPORAN HASIL BELAJAR PESERTA DIDIK

Nama Peserta Didik : Kelompok :

Nomor Induk : Semester :
Nama TK : Tahun Pelajaran :

NILAI AGAMA DAN BUDI PEKERTI PROJEK PENGUATAN PROFIL PELAJAR PANCASILA
.......................................................................................................................................................... ..........................................................................................................................................................

.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
JATI DIRI
.......................................................................................................................................................... Pertumbuhan Keterangan
Berat Badan : ...............................Kg Sakit : ............................ Hari
Tinggi Badan : ...............................Cm Izin : ............................ Hari
Alpa : ............................ Hari
..........................................................................................................................................................
..........................................................................................................................................................
.......................................................................................................................................................... Diberikan di : ...........................................
.......................................................................................................................................................... Pada tanggal : ...........................................
Mengetahui
Dasar-dasar Literasi, Matematika, Sains, Teknologi, Rekayasa Dan Seni Kepala TK Guru Wali

..........................................................................................................................................................

............................................... ...............................................
..........................................................................................................................................................
REFLEKSI ORANG TUA
..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... Surabaya,
.......................................................................................................................................................... Orang Tua
..........................................................................................................................................................
..........................................................................................................................................................
...............................................

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 LAPORAN HASIL BELAJAR PESERTA DIDIK

Nama Peserta Didik : Kelompok :

Nomor Induk : Semester :
Nama TK : Tahun Pelajaran :

NILAI AGAMA DAN BUDI PEKERTI PROJEK PENGUATAN PROFIL PELAJAR PANCASILA
.......................................................................................................................................................... ..........................................................................................................................................................

.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
..........................................................................................................................................................
..........................................................................................................................................................
JATI DIRI
.......................................................................................................................................................... Pertumbuhan Keterangan
Berat Badan : ...............................Kg Sakit : ............................ Hari
Tinggi Badan : ...............................Cm Izin : ............................ Hari
Alpa : ............................ Hari
..........................................................................................................................................................
..........................................................................................................................................................
.......................................................................................................................................................... Diberikan di : ...........................................
.......................................................................................................................................................... Pada tanggal : ...........................................
Mengetahui
Dasar-dasar Literasi, Matematika, Sains, Teknologi, Rekayasa Dan Seni Kepala TK Guru Wali

..........................................................................................................................................................

............................................... ...............................................
..........................................................................................................................................................
REFLEKSI ORANG TUA
..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... ..........................................................................................................................................................
.......................................................................................................................................................... Surabaya,
.......................................................................................................................................................... Orang Tua
..........................................................................................................................................................
..........................................................................................................................................................
...............................................

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