YAYASAN "SITI SARIFAH" YAYASAN "SITI SARIFAH"

SEKOLAH MENENGAH ATAS ISLAM ASY-SYIFA SEKOLAH MENENGAH ATAS ISLAM ASY-SYIFA
NPSN : 20238006 STATUS TERAKREDITASI “B” NPSN : 20238006 STATUS TERAKREDITASI “B”
Kampung Sampora Desa Jayasampurna Kec. Serang Baru Kabupaten Bekasi Kampung Sampora Desa Jayasampurna Kec. Serang Baru Kabupaten Bekasi
Telp. 081514584121 Akte Notaris : SININAYATI ISKANDAR,SH Telp. 081514584121 Akte Notaris : SININAYATI ISKANDAR,SH

BERITA ACARA PELAKSANAAN BERITA ACARA PELAKSANAAN

UJIAN SEKOLAH (US) UJIAN SEKOLAH (US)
TAHUN PELAJARAN 2023/2024 TAHUN PELAJARAN 2023/2024

Pada hari ini …....…........... Tanggal ….....…....................... Bulan ….......................... Tahun Dua Ribu Pada hari ini …....…........... Tanggal ….....…....................... Bulan ….......................... Tahun Dua Ribu
…................................. ….................................

a. Telah diselenggarakan Ujian Sekolah (US) dari pukul …...................... Sampai dengan a. Telah diselenggarakan Ujian Sekolah (US) dari pukul …...................... Sampai dengan
pukul ….................... pukul …....................
Pada Sekolah : …........................................... Pada Sekolah : …...........................................
Ruang : …........................................... Ruang : …...........................................
Alamat : …........................................... Alamat : …...........................................
Mapel : …........................................... Mapel : …...........................................
Kode Gabung Kelas : …........................................... Kode Gabung Kelas : …...........................................
Jumlah Peserta : Jumlah Peserta :
Seharusnya : ….......... Orang Seharusnya : ….......... Orang
Yang Hadir : ….......... Orang, Yakni Nomor : Yang Hadir : ….......... Orang, Yakni Nomor :
……..................................................................................................................................................... …….....................................................................................................................................................
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……..................................................................................................................................................... …….....................................................................................................................................................
……..................................................................................................................................................... …….....................................................................................................................................................
……..................................................................................................................................................... …….....................................................................................................................................................
Yang Tidak Hadir ….......... Orang, Yakni Nomor : Yang Tidak Hadir ….......... Orang, Yakni Nomor :
……..................................................................................................................................................... …….....................................................................................................................................................
……..................................................................................................................................................... …….....................................................................................................................................................
……..................................................................................................................................................... …….....................................................................................................................................................

b. Catatan selama pelaksanaan : b. Catatan selama pelaksanaan :

….................................................................................................................................................................................................... …....................................................................................................................................................................................................
….................................................................................................................................................................................................... …....................................................................................................................................................................................................
….................................................................................................................................................................................................... …....................................................................................................................................................................................................
Berita Acara ini dibuat dengan konsisi sebenarnya. Berita Acara ini dibuat dengan konsisi sebenarnya.

Pengawas I Pengawas II Pengawas I Pengawas II

1. Tanda Tangan : …................................... 1. Tanda Tangan : …................................... 1. Tanda Tangan : …................................... 1. Tanda Tangan : …...................................

2. Nama : …................................... 2. Nama : …................................... 2. Nama : …................................... 2. Nama : …...................................

3. NIP : …................................... 3. NIP : …................................... 3. NIP : …................................... 3. NIP : …...................................