SATUAN LAYANAN
BIMBINGAN DAN KONSELING
A. Topik
Permasalahan : …………………………………………………...........
B.
Tugas Perkembangan : ………………………………………………………...
C. Bidang Bimbingan : ………………………………………………………...
D. Jenis Layanan : ………………………………………………………...
E. Fungsi Layanan : ………………………………………………………...
F. Tujuan Layanan/Hasil yang ingin Dicapai :
1. ………………………………………………………………………………………
2. ………………………………………………………………………………………
3. ………………………………………………………………………………………
G. Sasaran
Layanan : .......................................................................................
H. Uraian
Kegiatan dan Materi Layanan
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I. Strategi
Pelayanan : .......................................................................................
J. Tempat
Penyelenggaraan : .......................................................................................
K. Waktu,
Tanggal, Semester : .......................................................................................
L. Penyelenggara Layanan : .......................................................................................
M. Pihak-pihak yang Disertakan dalam
Penyelenggaraan Layanan dan Peranannya Masing-masing :
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N. Alat Perlengkapan yang Digunakan :
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O. Rencana Penilaian dan Tindak
Lanjut layanan :
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P. Keterkaitan Layanan dengan
Kegiatan pendukung :
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Q. Catatan Khusus:
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Mengetahui
Kepala
Sekolah Guru
Pembimbing
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NIP. NIP.
Format ini digunakan untuk semua jenis layanan (yaitu
layanan orientasi, informasi, penempatan/penyaluran, konseling perseorangan,
bimbingan kelompok dan konseling kelompok
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