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BERITA ACARA

MUSYAWARAH DUSUN..............................
KAMPUNG.....................................................

Dalam rangka pelaksanaan program Nasional Pemberdayaan Masyarakat Mandiri


perdesaan ( PNPM-MPD ) Tahun Anggaran 2013 di kecamatan Dente Teladas Kabupaten Tulang
Bawang, Propinsi Lampung, Maka pada hari ini :

Hari dan Tanggal :...................., ..................2013


Waktu : Pukul ................ WIB s/d selesai
Tempat : .....................................................

Telah diselenggarakan musyawarah Dusun.............................................,


Kampung....................................... yang dihadiri oleh wakil-wakil dari masyarakat,serta unsur-
unsur lain yang terkait dengan pelaksanaan PNPM-MPD sebagai mana tercantum dalam daftar
hadir ( terlampir ).

Materi atau topik yang di bahas dalam forum ini serta yang bertindak selaku unsur
pimpinan rapat adalah :

A. Materi
- Konsepsi PNPM-MPD
- Sosialisasi Rencaana Penyusun RPJMDes dan RKP-Desa
- Pendataan RTM
- Pengalian Gagasan
- .........................................................................................................................................
- ...........................................................................................................................................
- ...........................................................................................................................................
- ..........................................................................................................................................

B. Unsur pimpinan rapat dan narasumber


- Pimpinan Rapat :........................................ dari ...............................................
- Sekertaris :........................................ dari ...............................................
- Narasumber :1. .................................... dari ...............................................
2. ................................... dari ...............................................
3. .................................... dari................................................
4 ..................................... dari ...............................................
5 ..................................... dari................................................

Setelah dilakukan pembahasan dan diskusi terhadap materi /topik di atas,selanjutnya


seluruh Peserta rapat memutuskan dan menyepakati beberapa hal yang berketepatan menjadi
keputusan dari musyawara, yaitu :

1. Menetapkan Kriteria RTM ,Miskin dan Sangat Miskin (Form. Terlampir)


2. Data RTM
3. Identifikasi Potensi dan Masalah (form Terlampir)
4. Peringkat Masalah dan Tindakan Pemecahan masalah ( gagasan)
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Demikianlah Berita Acaraini dibuat dan disahkan dengan penuh tanggung jawab agar
dapat dipertanggung jawabkan sebagai mana mestinya.

......................., ....................... 2013

Pemimpin Rapat Notulis

....................................... ....................................

Mengetahui :
Kepala Kampung ..............................

.....................................

Mengetahui/Menyetujui:
Wakil Dari Peserta Musyawarah Dusun

Nama Alamat Tanda Tangan

1. ............................................ ............................................ .............................................

2. ............................................ ............................................ .............................................

3. ............................................ ............................................ .............................................

4. ............................................ ............................................ ............................................

5. ............................................ ............................................ ............................................


DAFTAR HADIR
MUSYAWARAH DUSUN

Dusun : ..........................................
Hari/Tanggal : ..........................................
Tempat : ..........................................

no Nama L/P Alamat Tanda Tangan


1 1.
2 2.
3 3.
4 4.
5 5.
6 6.
7 7.
8 8.
9 9.
1 10.
0
11 11.
1 12.
2
1 13
3
1 14
4
1 15
5
1 16
6
1 17
7
1 18
8
1 19
9
2 20
0
2 21
1
2 22
2
2 23
3
2 24
4
2 25
5
2 26
6
2 27
7
2 28
8
2 29
9
3 30
0
3 31
1
3 32
2
3 33
3
3 34
4
3 35
5
3 36
6
3 37
7
3 38
8
3 39
9
4 40
0
4 41
1
4 42
2
4 43
3
4 44
4
4 45
5
4 46
6
4 47
7
4 48
8
4 49
9
no Nama L/P Alamat Tanda Tangan
50 50
5 51
1
5 52
2
5 53
3
5 54
4
5 55
5
5 56
6
5 57
7
5 58
8
5 59
9
6 60
0
6 61
1
6 62
2
6 63
3
6 64
4
6 65
5
6 66
6
6 67
7
6 68
8
6 69
9
7 70
0
7 71
1
7 72
2
7 73
3
7 74
4
7 75
5
7 76
6
7 77
7
7 78
8
7 79
9
8 80
0
8 81
1
8 82
2
8 83
3
8 84
4
8 85
5
8 86
6
8 87
7
8 88
8
8 89
9
9 90
0
9 91
1
9 92
2
9 93
3
9 94
4
9 95
5
9 96
6
9 97
7
9 98
8