Contoh Biodata Klien : Irman Siswanto (Ketua Umum)

	BIODATA KLIEN

 

Tanggal :                                  Hari :                                 No. Rujukan Klien :

Nama:	Nim:
Jurusan:	Tempat/Tgl Lahir:
Fakultas:	Pekerjaan:
Alamat Sekarang:	Jenis Kelamin:
Pekerjaan Orang Tua:	Agama:
Ibu:	Daerah Asal:
Bapak:	No kontak yang bias dihubungi:
Status perkawinan bapak:	E-mail:

(Silahkan beri tanda √ pada kotak yan dipilih)

Status Pendidikan           :               SD/MIN                                MTsN/ Sederajat                             MAN/Sederajat

                                                                S-1                          S-2                          S-3                          Lain-lain

Pendidkan Terakhir Selesai pada tahun:                                              

Status Perkawinan          :               Kawin                                   Belum kawin

                                                                Duda                                     Janda

Sumber rujukan                               :               Diri Sendiri         Kawan                  Ibu/Bapak           Dosen

                                                                Lain-lain: Silahkan Tulis:                                                                                                              

                                                                                                                                                                                                               

Jumlah Keluarga              : Anak Ke                             dari                        bersaudara

                                                                Abang                                   Kakak

                                                                Adik laki-laki                     Adik perempuan

Pertemuan Ke:                                                

	CATATAN KHUSUS SESI KONSELING

 

Tanggal :                           Waktu :                                 No. Rujukan Klien :

No Sesi:                                    Jenis Kasus:                            

A.     LATAR BELAKANG KLIEN

.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              

B.     PERNYATAAN MASALAH

.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      

C.     MASALAH YANG SEBENARNYA / DIKETAHUI PASTI

.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          

D.     PEMERHATIAN

.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              

E.      PENDEKATAN DAN TEKNIK YANG DIGUNAKAN

.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  

PERTEMUAN KEDEPAN ………………………………

TANGGAL……………………………………………….

                                                                                                            Konselor