PEMERINTAH PROPINSI JAWA
TIMUR
DINAS PENDIDIKAN
UPT SMA NEGERI I KRIAN
Jl. Gub. Soenandar Prijosudarmo 5,
krian Telp./Fax. (031) 8971528
email; sman1_krian@yahoo.com,
website; www.sman1krian.sch.id.
Nama Siswa :.................................
L / P Tanggal : .................................
Kelas :.................................
Kendala apa yang membuat anda
terlambat?
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Jam berapakah anda berangkat?
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Kendaraan apa yang anda pakai untuk
ke sekolah?
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Sudah berapa kali anda berangkat?
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Butuh waktu berapa lama anda untuk
datang ke sekolah?
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Apabil Anda terlambat, kerugian apa yang
anda dapat?
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Bagaimana cara anda supaya tidak
terlambat lagi?
............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................... Krian,
Guru Pembimbing / Konselor Siswa
Yang Bersangkutan,
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