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    Home Visit Record

    Uploaded by

    Ruth Gultiano
    Home Visit Record

    Copyright:

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

    Home Visit Record

    Uploaded by

    Ruth Gultiano
    0 views2 pages
    Home Visit Record

    Copyright

    © © All Rights Reserved

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    DOCX, PDF, TXT or read online from Scribd

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    Home Visit Record

    Copyright:

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

    Home Visit Record

    Uploaded by

    Ruth Gultiano
    Home Visit Record

    Copyright:

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

    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:

    ________________________________________________________________________________________________________

    Address: Sayre Highway, Sinangguyan, Don Carlos, Bukidnon


    Contact No.: 0927 675 7183
    Email: seniorhigh.dcnhs@gmail.com
    ________________________________________________________________________________________________________
    _________________________________________________________________________________________________

    _________________________________________
    Signature of Parent/ Guardian

    Address: Sayre Highway, Sinangguyan, Don Carlos, Bukidnon


    Contact No.: 0927 675 7183
    Email: seniorhigh.dcnhs@gmail.com

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