Rabu, 30 Mei 2012

laporan kunjungan rumah

pgriYAYASAN 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                          : ...................................................................

  1. Tujuan Home Visit                  : Mencari dan menggali informasi yang berhubungan   
                                                        dengan masalah klien
     
  1. Hasil Wawancara                    :
·         Kebiasaan Belajar klien di rumah
......................................................................................................................................................................................................................................................................................................

·         Aktivitas klien
......................................................................................................................................................................................................................................................................................................
·         Kedekatan klien dengan anggota keluarga :
......................................................................................................................................................................................................................................................................................................

·         Apakah klien sering terbuka mengemukakan permasalahannya
......................................................................................................................................................................................................................................................................................................
·         Apakah orang tua pernah mengecek buku/catatan :
......................................................................................................................................................................................................................................................................................................

  1. Kesimpulan :
1.      ......................................................................................................................................................................................................................................................................................................

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

  1. Catatan            : 
......................................................................................................................................................................................................................................................................................................

                                                                                                .........................., .................                    
       Mengetahui
Kepala Sekolah                                                           Guru BK /Konselor


       Dra. Ambarwati Kusuma Dewi                                  Wiwit Setiyono, S.Pd

Tidak ada komentar:

Poskan Komentar