contoh sap
TRANSCRIPT
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN BAHASA INGGRISFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 1 dari 18 Halaman ( )
Mata Kuliah : Bahasa Inggris I Dosen : Team Teaching
Kode Mata Kuliah Kode Dosen
Universitas Jurusan : Elektro
Fakultas : Politeknik Negeri Padang Program Studi : D.4 Elektronika/Industri
Konsentrasi :
Tahun Akademik : 2010/2011Semester : I (Satu)
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 101 - Greeting and Leave
Takings- Students are able
to know and practice how to give a conversational sign or word of welcome or pleasure when meeting somebody or receiving a guest and how to close a conversation or leave taking
- Students are able to identify the formal and informal greetings and leave takings
- Students are able to express greetings politely or welcomingly when meeting a person whom they have the greatest respect or their colleagues and leave takings in a formal or informal situations
- Formal Greetings and Leave Takings
- Informal Greetings and Leave Takings
- Exercises
- Evaluate the students’ ability in using special expressions in formal and informal greetings and leave takings
- Practice using greetings and leave takings in dialogs (in pairs)
LCD- - Module of
Teaching Instruction
- (Chapter 1)
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan JabatanTanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN BAHASA INGGRISFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 2 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 102 - Introductions and Getting
to Know You- To help students
learn the English personal information, rules and practice them in conversational situations
- Students are able to give simple presentation about self information inside the class
- to answer questions based on what information they give or give comments to the content of the other student’s presentation
- Personal Information
- Demonstrate the introduction in the form of presentation
- Breaks the students into small groups
- Anticipate any vocabulary they need
- Evaluate the students and give scores of pronunciation, content, and fluency
- Practice introducing themselves by using questions guidance concerning personal information
- Have simple presentation in 2 or 3 minutes and stand up in front of the class.
- Answer 2 or more questions that his friends may have
LCD- - Module of
Teaching Instruction
- (Chapter II)
3 - Introductions and Getting to Know You
(Continuation….)
- idem - idem - Introduction and Meeting New People
- Demonstrate some very common expressions used in
- Practice the dialogs concerning the introduction of meeting new
-
LCD- - Module of
Teaching Instruction
- (Chapter II-Part 2)
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN BAHASA INGGRISFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 3 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - - - introduction
with new people
- Anticipate any vocabulary they need
- Improve students’ pronunciation and intonation
-
people - do some
exercises available in the form of dialogs
- -
4 - Parts of Speech - Students are able to know Parts of Speech in English language that have been grouped into eight classes.
- Students are able to identify the Nouns, Pronouns, Adjectives, Verbs, Adverbs, Prepositions, Conjunctions, and interjections according to their function, that is according to the
- the Nouns, Pronouns, Adjectives, Verbs, Adverbs, Prepositions, Conjunctions, and interjections
- Help students to understand more about each part of speech and give more examples
- Practice using those parts of speech by doing exercises
LCD- - Module of
Teaching Instruction
- (Chapter III)
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN BAHASA INGGRISFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 4 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - work that they do
and not according to their form.
- Students are able to make sentences using those words as different parts of speech
- - - - -
5 - Familiar Prefixes and Suffixes
- Students are able to use the methods of vocabulary building by knowing the meaning of affixes that can help them make reasonable guesses at what a word means
- Students are able to identify all the roots, prefixes and suffixes in the word
- To study the five common affixes, such as –re; -able; -full; -ly
- to break the word down into meaningful parts to make a reasonable guess at the meaning of a word
- Affixes, - “One Who”
suffixes,- Noun Suffixes,-
- Explain the function of common affixes, “One Who” Suffixes, and Noun Suffixes that carry special meanings
- Help students to understand the meaning of words related to affixes, “One Who” Suffixes, and Noun Suffixes
- Practice through exercises by explaining the meaning of group of words having affixes, “One Who” Suffixes, and Noun Suffixes
LCD- - Module of
Teaching Instruction
- (Chapter IV)
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN BAHASA INGGRISFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 5 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 106 - Familiar Prefixes and
Suffixes(Continuation…)
idem idem - Adjective Suffixes,
- Verb Suffixes,- Negative Prefixes
- Explain the function of common Adjective Suffixes, Verb Suffixes,Negative Prefixes that carry special meanings
- Help students to understand the meaning of words related to Adjective Suffixes, Verb Suffixes,Negative Prefixes
- Practice through exercises by explaining the meaning of group of words having Adjective Suffixes, Verb Suffixes,Negative Prefixes
LCD- - Module of
Teaching Instruction
- (Chapter IV – Part 2)
7 - Verbalizing Numbers and Mathematical Operation
- Students are able to express numbers and write the mathematical
Students are able to:
- Read all of English numbers from one to
- Verbalizing numbers
- Mathematical symbols
- Greek Letters and
- Evaluate students ability in counting numbers
- Practice counting numbers, mathematical symbols, and
LCD- - Module of
Teaching Instruction
- (Chapter V)
symbols used in engineering
hundred, to thousand
-
Abbreviation used in Engineering
- Help students to study and
Greek Letters- Doing
exercises
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN BAHASA INGGRISFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 6 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - - Read address and
numbers, telephone numbers, and zip code
- Write the mathematical symbols used in engineering,
- write mathematical symbols and Greek Letters
- -
8 - Describing People and Occupation
- Students are able to describe people and their occupation through information and pictures or photos available for them
- Students are able to give the description of people based on information or pictures and photos
- Have dialogs in pairs by asking and answering questions concerning the people, someone or classmate and their occupation
Conversation in context :
- Pair up and Practice
- Look and Read Information
-
- Breaks students into small groups or in pair
- Demonstrate the way to describe people by having conversation
- Evaluate the students ability in describing people using
- Practice describing people, pictures, or photos in small groups and asking / answering questions in groups
LCD- - Module of
Teaching Instruction
- (Chapter VI)
pictures or photos
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN BAHASA INGGRISFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 7 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 109 - Describing People and
Occupation(Continuation….)
idem idem - Talk about people using photos and models
- Presentation:Describe own family, friends, and other own pictures
- Break students in pairs
- Evaluate students’ pronunciation, intonation, vocabulary, and fluency
- Practice talking about photos and models
- Telling their own family trees in pairs and conversation in context
LCD- - Module of
Teaching Instruction
- (Chapter VI)
10 - Ask fir and Give Directions - Students are able to describe the location of places through a map
- To ask for and give information or direction on how to reach a destination or places
- The students are able to study a map locations and describe how to get a location showed on the map.
- To have conversation in pairs, ask for and give information or direction of how to get to a certain place.
- Conversation Practice:How to get to a location
- Break students in pair
- Evaluate students’ pronunciation, intonation, vocabulary, and fluency
- Practice in pairs: Make conversation of how to get to a location
LCD- - Module of
Teaching Instruction
- (Chapter VII)
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN BAHASA INGGRISFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP) Edisi 01Revisi 0Berlaku EfektifHalaman 8 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 1011 - Ask fir and Give Directions
(Continuation….)Idem Idem - Conversation
Practice:How to give directions
- Break students in pair
- Evaluate students’ pronunciation, intonation, vocabulary, and fluency
- Practice in pairs:Make conversation and take turns giving directions
LCD- - Module of
Teaching Instruction
- (Chapter VII - Part 2)
12 - Position of an Object - Students are able to recognize prepositions of prepositional phrases usually used to explain the position of an object
- To explain the position of an object to its place and to other objects by using different sentence patterns
- Students are able to use some prepositions or prepositional phrases in a different sentence patterns to explain the position of an object to its place
- Preposition of Location
- Introduce prepositions or prepositional phrases
- Introduce Sentence Patterns
- Practice explaining the position of an object in a sentence based on its locations
- Name the components used in electrical circuit in different sentences based on the
LCD- - Module of
Teaching Instruction
- (Chapter VIII - Part 1)
symbols on pictures
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN BAHASA INGGRISFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP) Edisi 01Revisi 0Berlaku EfektifHalaman 9 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 1013 - Position of an Object
(Continuation…)Idem Idem - Position of objects
between other objects
- Evaluate students ability in explaining the position of objects as seen on pictures and positions of objects between other objects
- Practice explaining the position of objects showed on pictures
- Practice explaining positions of objects between each other
LCD- - Module of
Teaching Instruction
- (Chapter VIII - Part 2)
14 - Properties of Materials - Students are able to recognize a number of adjectives and nouns that are usually used to explain the properties of engineering
- Students are able to explain the properties of engineering materials, the similarities and differences, and the comparison.
- Sentence Patterns Using Adjectives and Nouns
- Similarities and Differences of Materials
- Introduce a number of adjectives and nouns used to express the properties of materials
- Demonstrate
- Practice using adjectives and nouns in different sentences to explain the properties of materials
LCD- - Module of
Teaching Instruction
- (Chapter IX)
materials the use of different sentence patterns for the element properties.
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN BAHASA INGGRISFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 10 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 1015 - Properties of Materials
(continuation …..)idem idem - Pictures and Text - Evaluate
students’ understanding text through pictures
- Try to understand the text and practice retelling the pictures orally
- Practice making sentences as definition through tables of the properties of materials.
LCD- - Module of
Teaching Instruction
- (Chapter IX – Part 2)
15 - Describing Objects(Shapes and Dimension; Measurement; Parts of Object; Function of the Object)
- Students are able to describe the shapes and dimension of objects, measurements,
- Students are able to explain the shape and positions of two and three dimensional
- Shapes and Dimensions
- -LCD
- -
parts of object, and function of the object
objects by using nouns and adjectives in definitions
- To use the nouns and adjectives in
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN BAHASA INGGRISFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 11 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - general
statements of dimensions (measurement)to describe the parts of object and their function
- - - - -
- - - - - - -
- - - - - - -
- - - - - - -
- - - - - - -
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN ELEKTROFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 13 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - - - - - - -- - - - - - - -- - - - - - - -
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN ELEKTROFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 13 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - - - - - - -- - - - - - - -- - - - - - - -
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN ELEKTROFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 14 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - - - - - - -- - - - - - - -- - - - - - - -
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN ELEKTROFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 14 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - - - - - - -- - - - - - - -- - - - - - - -
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN ELEKTROFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP) Edisi 01Revisi 0Berlaku EfektifHalaman 15 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - - - - - - -- - - - - - - -- - - - - - - -
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN ELEKTROFORMULIR No. Formulir FOR/XXX/000.000-E1R0
Edisi 01
SATUAN ACARA PERKULIAHAN (SAP)Revisi 0Berlaku EfektifHalaman 16 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - - - - - - -- - - - - - - -- - - - - - - -
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN ELEKTROFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 16 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - - - - - - -- - - - - - - -- - - - - - - -
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN ELEKTROFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP) Edisi 01Revisi 0Berlaku EfektifHalaman 17 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - - - - - - -- - - - - - - -- - - - - - - -
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN ELEKTROFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 17 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - - - - - - -- - - - - - - -- - - - - - - -
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan
DEPARTEMEN PENDIDIKAN NASIONAL
POLITEKNIK NEGERI PADANG
JURUSAN ELEKTROFORMULIR No. Formulir FOR/XXX/000.000-E1R0
SATUAN ACARA PERKULIAHAN (SAP)Edisi 01Revisi 0Berlaku EfektifHalaman 18 dari 18 Halaman ( )
Minggu Pokok Bahasan TIU TIK Materi KuliahKegiatan
Media Evaluasi Ket.Dosen Mahasiswa
1 2 3 4 5 6 7 8 9 10- - - - - - - -- - - - - - - -- - - - - - - -
Dibuat Diperiksa DisetujuiTanggal Tanggal TanggalOleh Oleh OlehJabatan Jabatan Jabatan
Tanda Tangan Tanda Tangan Tanda Tangan