Catatan Home Visit Sma 5 Plbg
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PEMERINTAH KOTA PALEMBANG DINAS PENDIDIKAN PEMUDA DAN OLAHRAGA SMA NEGERI 5 PALEMBANG Jalan Gotong Royong Sungai Buah, Provinsi Sumatera Selatan Telepon (0711) 713259 Fax (0711) 713259 Palembang 30116 Website :http://www.sman5palembang.sch.id CATATAN HOME VISIT KELENGKAPAN DATA BIMBINGAN YANG SEDANG DI KUMPULKAN , A.N : Nama Konseli :........................................................ ........................................................... Kelas / Tahun Ajaran : ....................................................... ............................................................ Jenis masalah : ....................................................... ............................................................ Nama orang Tua : ....................................................... ............................................................ Alamat Rumah : ....................................................... ............................................................ KRONOLOGI PELAKSANAAN HOME VISIT : URAIAN SINGKAT KEBERANGKATAN 1. Hari / tanggal / jam berangkat :........................................................ ............................................... 2. Data yang ingin diperoleh dari kegiatan HOME VISIT :....................................................... ..................... .............................................................. .............................................................. ...................................... .............................................................. .............................................................. ...................................... .............................................................. .............................................................. ......................................
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Transcript of Catatan Home Visit Sma 5 Plbg
PEMERINTAH KOTA PALEMBANGDINAS PENDIDIKAN PEMUDA DAN OLAHRAGA
SMA NEGERI 5 PALEMBANGJalan Gotong Royong Sungai Buah, Provinsi Sumatera SelatanTelepon (0711) 713259 Fax (0711) 713259 Palembang 30116
Website :http://www.sman5palembang.sch.id
CATATAN HOME VISIT
KELENGKAPAN DATA BIMBINGAN YANG SEDANG DI KUMPULKAN , A.N :Nama Konseli
:...................................................................................................................Kelas / Tahun Ajaran
: ...................................................................................................................Jenis masalah
: ...................................................................................................................Nama orang Tua
: ...................................................................................................................Alamat Rumah
: ...................................................................................................................
KRONOLOGI PELAKSANAAN HOME VISIT :URAIAN SINGKAT KEBERANGKATAN
1. Hari / tanggal / jam berangkat :.......................................................................................................
2. Data yang ingin diperoleh dari kegiatan HOME VISIT :......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
URAIAN SINGKAT HASIL DARI HOME VISIT :......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
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TINDAK LANJUT :............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Palembang,Konselor
(.............................................................)NIP.
PEMERINTAH KOTA PALEMBANGDINAS PENDIDIKAN PEMUDA DAN OLAHRAGA
SMA NEGERI 5 PALEMBANGJalan Gotong Royong Sungai Buah, Provinsi Sumatera SelatanTelepon (0711) 713259 Fax (0711) 713259 Palembang 30116
Website :http://www.sman5palembang.sch.id
CATATAN KONSELING
KELENGKAPAN DATA BIMBINGAN YANG SEDANG DIKUMPULKAN , A.N :Nama Konseli
: ......................................................................................................................Kelas / T.A
: ......................................................................................................................Pertemuan
: ......................................................................................................................
Hari/tanggal/jam: ...................................................................................................................
...
1. ANALISA DATA
KELUHAN AWAL :..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
DATA YANG RELEVAN DENGAN KELUHAN KONSELI :..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
2. DIAGNOSA
IDENTIFIKASI MASALAH Kesehatan fisik Kesehatan mental : Hubungan keluarga : : Keadaan sosial ekonomi : Hubungan sosial di rumah : Hubungan sosial di sekolah : Pemanfaatan waktu senggang :
3. THREATMENTPendekatan konseling yang relevan :
Client centered Directive Psikoanalisa
Alternatif penyelesaian masalah / pemenuhan terhadap kekurangan kekurangan :
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4. TINDAK LANJUT TAHAP I
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TAHAP II: .....................................................................................
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TAHAP III: .....................................................................................
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Palembang,
Konselor
(.....................................................................)
NIP.
