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    Home Visit Record

    Uploaded by

    Mary Jean Romulo-Holanda
    The document contains a home visit record template used to collect information about a student's personal details, family, economic situation, scholastic standing, and recommendations. It requests information such as the student and family members' names, ages, occupations, income, religion, home address, materials used to build the home, facilities available, and language spoken at home.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Home Visit Record

    Uploaded by

    Mary Jean Romulo-Holanda
    4 views2 pages
    The document contains a home visit record template used to collect information about a student's personal details, family, economic situation, scholastic standing, and recommendations. It requests information such as the student and family members' names, ages, occupations, income, religion, home address, materials used to build the home, facilities available, and language spoken at home.

    Original Title

    HOME VISIT RECORD

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    © © All Rights Reserved

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    The document contains a home visit record template used to collect information about a student's personal details, family, economic situation, scholastic standing, and recommendations. It requests information such as the student and family members' names, ages, occupations, income, religion, home address, materials used to build the home, facilities available, and language spoken at home.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    4 views2 pages

    Home Visit Record

    Uploaded by

    Mary Jean Romulo-Holanda
    The document contains a home visit record template used to collect information about a student's personal details, family, economic situation, scholastic standing, and recommendations. It requests information such as the student and family members' names, ages, occupations, income, religion, home address, materials used to build the home, facilities available, and language spoken at home.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Republic of the Philippines

    Department of Education
    ___________________
    _____________________
    ___________________________

    HOME VISIT RECORD

    Date

    Time

    I. Pupil’s Personal Information:

    Name Nick Name Grade

    Place of Birth Date of Birth Gender

    II. Family Information:


    Father
    Name Age Occupation
    Salary Educational Attainment Religion

    Mother
    Maiden Name Age Occupation
    Salary Educational Attainment Religion

    Guardian
    Name Relationship Age
    Occupation Salary Educational Attainment
    Business Address of
    Parent/Guardian
    Position of the Pupil in the
    Family
    Siblings (Eldest to Youngest)

    III. Economic Information


    1. Financial Status
    ❑Excellent ❑Good ❑Moderate ❑ Poor
    2. Type of Dwelling
    ❑Single Attached ❑Row ❑Duplex ❑Mansion ❑Others
    ❑Owned ❑Rented ❑
    3. Materials of the House
    ❑A. Concrete ❑B. Wood ❑A & B ❑Make shift ❑ Others
    4. Facilities Available
    ❑Radio ❑ Television ❑Dining set ❑Refrigerator
    ❑ Computer set ❑Gas Stove ❑Gadgets ❑not on the list
    5. Language or Dialect Spoken at Home:
    ❑Mother Tongue ❑Filipino ❑English ❑Others pls specify
    6. Food production activities:
    ❑Home cooked ❑Carendiria ❑Fast food ❑Others pls specify
    7. Kind of fence:
    ❑Concrete ❑Wood ❑Make Shift ❑ Others pls specify
    8. How animals are kept:
    ❑Caged ❑Leashed ❑N/A
    9. Is there a compost pit:
    ❑Observed ❑ None

    IV. Scholastic Standing:

    ____________________________________________________________________________________________________________________
    ____________________________________________________________________________________________________________________
    ____________________________________________________________________________________________________________________
    V. Recommendation:
    ____________________________________________________________________________________________________________________
    ____________________________________________________________________________________________________________________
    ____________________________________________________________________________________________________________________

    _________________________________________
    Signature of Parent/ Guardian

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