Jose de Villa National School: Home Visitation Form
Jose de Villa National School: Home Visitation Form
Jose de Villa National School: Home Visitation Form
Region V
Division of Camarines Sur
Jose de Villa National School
Manguiring, Calabanga, Camarines Sur
_______________________________________________________________________________________________
------------------------
(Grade Level- Section)
Date : _________________________
Time : _________________________
Name : _________________________
Reason for Home Visitation : (Example only: Non-getting and submission of
modules
Difficulty in communicating with the learner as
well as the parents.
Remediation activity (Grade 9 back subject)
Attitude towards schooling
Other concerns)
1. ________________________________________________________________________
__________________________________________________________________
2. ________________________________________________________________________
__________________________________________________________________
3. ________________________________________________________________________
__________________________________________________________________
4. ________________________________________________________________________
__________________________________________________________________
5. ________________________________________________________________________
__________________________________________________________________
____________________________ _____________________________
Parent’s name and signature over printed names Adviser’s name and signature over printed names
Parent’s Contact No. ____________________________
_______________________________________________________________________________________________
DROPPING FORM
SY 2020-2021
I, ____________________________________________________, parent/guardian of
_____________________________________ of Grade ________(Grade& Section) am officially dropping out
my son/ daughter from this school, effective ____________________________due to the following reason/s:
(pls. check)
INDIVIDUAL-RELATED FACTORS
_________ illness
_________ overage
_________ death
_________ drug abuse
_________ poor academic performance
_________ lack of interest/distractions
_________ hunger malnutrition
SCHOOL-RELATED FACTORS
_________ teacher factor
_________ physical condition of classroom
_________ peer influence
GEOGRAPHIC/ENVIRONMENTAL
_________ distance between home and school/ change of residence
_________ armed conflict
_________ calamities and disasters
FINANCIAL RELATED
_________ child labor, work
Noted:
____________________ ______________________
Year Level Adviser Secondary School Principal I