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    Home Visit Record

    Uploaded by

    KIM KARL CAHILIG
    This document contains a home visit record template for a student named Juan Dela Cruz Magsikap. It collects information in 5 sections: [1] the student's personal details, [2] family information, [3] economic status of the family, [4] the student's scholastic standing, and [5] recommendations. The form leaves space to note details like parents' occupations, the family's living situation and available facilities, as well as the student's performance and any suggestions following the home visit.

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

    Home Visit Record

    Uploaded by

    KIM KARL CAHILIG
    13 views3 pages
    This document contains a home visit record template for a student named Juan Dela Cruz Magsikap. It collects information in 5 sections: [1] the student's personal details, [2] family information, [3] economic status of the family, [4] the student's scholastic standing, and [5] recommendations. The form leaves space to note details like parents' occupations, the family's living situation and available facilities, as well as the student's performance and any suggestions following the home visit.

    Original Description:

    TEMPLATE

    Original Title

    HOME-VISIT-RECORD

    Copyright

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    This document contains a home visit record template for a student named Juan Dela Cruz Magsikap. It collects information in 5 sections: [1] the student's personal details, [2] family information, [3] economic status of the family, [4] the student's scholastic standing, and [5] recommendations. The form leaves space to note details like parents' occupations, the family's living situation and available facilities, as well as the student's performance and any suggestions following the home visit.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    13 views3 pages

    Home Visit Record

    Uploaded by

    KIM KARL CAHILIG
    This document contains a home visit record template for a student named Juan Dela Cruz Magsikap. It collects information in 5 sections: [1] the student's personal details, [2] family information, [3] economic status of the family, [4] the student's scholastic standing, and [5] recommendations. The form leaves space to note details like parents' occupations, the family's living situation and available facilities, as well as the student's performance and any suggestions following the home visit.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    R epublic of the P hilippines

    D epartment of E ducation
    Region IV-A CALABARZON
    SCHOOLS DIVISION OF SANTA ROSA CITY
    BALIBAGO INTEGRATED HIGH SCHOOL
    Kabesang Moldes St., Brgy. Balibago, City of Santa Rosa
    Attachment # 1.

    HOME VISIT RECORD

    Date     Juan Dela Cruz Magsikap

    Time

    I. Pupil’s Personal Information:

    Name  Nick Name Grade

    Place of Date of Birth Gende


    Birth r

    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)


    R epublic of the P hilippines
    D epartment of E ducation
    Region IV-A CALABARZON
    SCHOOLS DIVISION OF SANTA ROSA CITY
    BALIBAGO INTEGRATED HIGH SCHOOL
    Kabesang Moldes St., Brgy. Balibago, City of Santa Rosa

    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:


    R epublic of the P hilippines
    D epartment of E ducation
    Region IV-A CALABARZON
    SCHOOLS DIVISION OF SANTA ROSA CITY
    BALIBAGO INTEGRATED HIGH SCHOOL
    Kabesang Moldes St., Brgy. Balibago, City of Santa Rosa

    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _________________________________________________________________________

    V. Recommendation:

    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _________________________________________________________________________

    ___________________________________

    Signature of Parent/ Guardian

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