Berita Acara Simulasi 1

BERITA ACARA PELAKSANAAN SIMULASI UNBK TAHUN PELAJARAN 2017/2018

Pada hari ini _____________ tanggal ___________________ ___________________ bulan ________________ __________________tahun __tahun 2017, telah diselenggarakan Ujian Nasional CBT untuk Progr am Studi ______________, Mata Pelajaran _____________________, _____________________, dari pukul _________ sampai dengan pukul _________, sesi _______. 1.

Provinsi Provins i

: _________________________________ _______________ __________________________________ _______________________________ _______________

Kota/Kabupate Kota/ Kabupaten n

: _________________________________ _______________ __________________________________ _______________________________ _______________

Sekolah/Madr Sekol ah/Madrasah asah

: _________________________________ _______________ __________________________________ _______________________________ _______________

Tempat penyelenggaraan

: ___________________ ____________________________ __________________ __________________ ____________________ __________________ _______

Ruang

: ________________________________ _______________ __________________________________ ________________________________ _______________

Jumlah peserta pesert a seharusnya seharusn ya

: _________________________________ _______________ __________________________________ _______________________________ _______________

Jumlah Hadir (Ikut Ujian)

: _________________________________ _______________ __________________________________ _______________________________ _______________

Jumlah Tidak Hadir

: _________________________________ _______________ __________________________________ _______________________________ _______________

No.Peserta No.Pese rta yang Tidak Hadir

: _________________________________ _______________ _______________________________ ______________________________ __________________ _  __________________  ___________________________ ___________________ ____________________ ______________________ _________________ _____

2. Catatan selama pelaksanaan ujian: Pengawas:  __________________  ____________________________ ___________________ _________________ _________________ __________________ ______________________ ______________________ ___________ __  __________________  ____________________________ ___________________ _________________ _________________ __________________ ___________________ ___________________ _________________ __________ __ Proktor:  __________________  _____________________________ ____________________ __________________ ___________________ ___________________ _____________________ _____________________ ____________ ___  __________________  ____________________________ ___________________ _________________ _________________ __________________ ___________________ ___________________ _________________ __________ __ Teknisi:  __________________  ____________________________ ___________________ _________________ ____________________ ____________________ ___________________ ____________________ ______________ _____  __________________  ____________________________ ___________________ _________________ _________________ __________________ ___________________ ______________________ ___________________ _______

Yang membuat berita acara: Jabatan

Nama

TTD

1. Pengawas Pengaw as NIP

_______________________________ _______________ ________________ _______________________________

1. ____________________ _______________ _____

2. Proktor Prokto r NIP

_______________________________ _______________ ________________ _______________________________

2. ____________________ _______________ _____

3. Teknisi NIP

_______________________________ _______________ ________________ _______________________________

3. 3 . ____________________ _______________ _____

Catatan:

- 1 (satu) eksemplar untuk Sekolah/Madrasah - 1 (satu) eksemplar untuk Kabupaten/Kota - 1 (satu) eksemplar untuk Pusat

KEMENTERIAN PENDIDIKAN DAN KEBUDAYAAN