7.6 Kartu Status Konseling

SMP ISLAM AL-AZHAR KELAPA GADING JAKARTA J AKARTA

KARTU STATUS KONSELING

No. Dok No. Revisi No. Terbit Tgl Berlaku Halaman

: F/BK/11 : 00 : : : 1 dari 6

KARTU STATUS KONSELING I.

IDENTITAS 1. Nama Lengkap Siswa 2. Nama Panggilan Siswa 3. No. induk sekolah/ BK 4. Kelas

5. 6. 7. 8.

Tempat, tanggal lahir Jenis kelamin Agama Alamat rumah

9. Anak ke 10. No. Telp/ HP 11. Nama orangtua/ wali 12. Pekerjaan orangtua/ wali

II.

: : : :

................................................... ............................................................................. ............................ .. ................................................... ............................................................................. ............................ .. ................................................... ............................................................................. ............................ .. ........................ Tahun........................................... ........................................... ........................ Tahun........................................... ........................................... ........................ Tahun........................................... ........................................... ........................ Tahun........................................... ........................................... : ................................................... ............................................................................. ............................ .. : ................................................... ............................................................................. ............................ .. : ................................................... ............................................................................. ............................ .. : ................................................... ............................................................................. ............................ .. ................................................... ............................................................................. ............................ .. : ........................ dari ............................ ............................ bersaudara : ................................................... ............................................................................. ............................ .. : Ayah : ................................................... ..................................................................... .................. Ibu : .............................................................. ........................................................................ .......... : Ayah : ................................................... ..................................................................... .................. Ibu : .............................................................. ........................................................................ ..........

STATUS KONSELING No.

Hari, Tanggal

Hasil Konseling

Catatan

SMP ISLAM AL-AZHAR KELAPA GADING JAKARTA J AKARTA

KARTU STATUS KONSELING

No.

Hari, Tanggal

Hasil Konseling

No. Dok No. Revisi No. Terbit Tgl Berlaku Halaman

: F/BK/11 : 00 : : : 2 dari 6

Catatan

SMP ISLAM AL-AZHAR KELAPA GADING JAKARTA J AKARTA

KARTU STATUS KONSELING

No.

Hari, Tanggal

Hasil Konseling

No. Dok No. Revisi No. Terbit Tgl Berlaku Halaman

: F/BK/11 : 00 : : : 3 dari 6

Catatan

SMP ISLAM AL-AZHAR KELAPA GADING JAKARTA J AKARTA

KARTU STATUS KONSELING

No.

Hari, Tanggal

Hasil Konseling

No. Dok No. Revisi No. Terbit Tgl Berlaku Halaman

: F/BK/11 : 00 : : : 4 dari 6

Catatan

SMP ISLAM AL-AZHAR KELAPA GADING JAKARTA J AKARTA

KARTU STATUS KONSELING

No.

Hari, Tanggal

Hasil Konseling

No. Dok No. Revisi No. Terbit Tgl Berlaku Halaman

: F/BK/11 : 00 : : : 5 dari 6

Catatan

SMP ISLAM AL-AZHAR KELAPA GADING JAKARTA J AKARTA

KARTU STATUS KONSELING

No. Dok No. Revisi No. Terbit Tgl Berlaku Halaman

: F/BK/11 : 00 : : : 6 dari 6