laporan kunjungan rumah

YAYASAN PEMBINALEMBAGA PENDIDIKAN (YPLP) DIKDASMEN PGRI KOTA TEGAL

SMK PGRI KOTA TEGAL

 STATUS TERAKREDITASI

Jl. Halmahera No. 59  Telp./Fax (0283) 358738 Kota Tegal 52121

           

LAPORAN KUNJUNGAN RUMAH

Nomor : ...............................

A.    Identitas

1.      Kode Konseli        : .......................................

Nama Siswa         : ........................................

Kelas                    : .....................................

Agama                  : .........................................

Alamat                  : ..........................................

2.      Orang Tua

·         Nama Ayah                  : .................................

·         Pekerjaan                      : .....................................................................

·         Alamat                          : ......................................................................

·         Ibu                                : .....................................................................

·         Pekerjaan                      : .....................................................................

·         Alamat                          : ...................................................................

2. Tujuan Home Visit                  : Mencari dan menggali informasi yang berhubungan   

                                                        dengan masalah klien

     

3. Hasil Wawancara                    :

·         Kebiasaan Belajar klien di rumah

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·         Aktivitas klien

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·         Kedekatan klien dengan anggota keluarga :

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

·         Apakah klien sering terbuka mengemukakan permasalahannya

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

·         Apakah orang tua pernah mengecek buku/catatan :

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4. Kesimpulan :

1.      ......................................................................................................................................................................................................................................................................................................

2.      ......................................................................................................................................................................................................................................................................................................

5. Catatan            : 

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                                                                                                .........................., .................                    

       Mengetahui

Kepala Sekolah                                                           Guru BK /Konselor

       Dra. Ambarwati Kusuma Dewi                                  Wiwit Setiyono, S.Pd