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Name Nick Name Grade Place of Birth Date of Birth Gender: Deped Tambayan PH

The document appears to be a home visit record form used by the Department of Education in the Philippines to collect information about students' personal details, family, economic situation, and scholastic standing. It requests identifying information about the student and parents/guardians, as well as details about the family's finances, living situation, language spoken at home, and more. Educators would fill this out during home visits to students to better understand their living circumstances and needs.

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50 views1 page

Name Nick Name Grade Place of Birth Date of Birth Gender: Deped Tambayan PH

The document appears to be a home visit record form used by the Department of Education in the Philippines to collect information about students' personal details, family, economic situation, and scholastic standing. It requests identifying information about the student and parents/guardians, as well as details about the family's finances, living situation, language spoken at home, and more. Educators would fill this out during home visits to students to better understand their living circumstances and needs.

Uploaded by

anon_692624978
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

DEPARTMENT OF EDUCATION
Region X
Division of Cagayan de Oro
East I District
DEPED TAMBAYAN PH
https://www.depedtambayanph.net

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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