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Home Visit Record

This document contains a home visit record for a student at Antonio National High School. It collects information about the student's personal details, family, economic status, scholastic standing, and recommendations. Sections include the student's name, family members, parent occupations, type of housing, available facilities, language spoken at home, food sources, fence and animal keeping, and compost availability. The form is signed by the student's parent or guardian.

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Limas Elem Tigbao
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30 views

Home Visit Record

This document contains a home visit record for a student at Antonio National High School. It collects information about the student's personal details, family, economic status, scholastic standing, and recommendations. Sections include the student's name, family members, parent occupations, type of housing, available facilities, language spoken at home, food sources, fence and animal keeping, and compost availability. The form is signed by the student's parent or guardian.

Uploaded by

Limas Elem Tigbao
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 IX
Schools Division of Zamboanga del Sur
ANTONIO NATIONAL HIGH SCHOOL

HOME VISIT RECORD

Date
Time
I. Pupil’s Personal Information:

Name Nick Name Grade


Last Name, First Name, Middle Name

Place of Birth Date of Birth Gender


II. Family Information:
Father
Name Age Occupation
Last Name, First Name, Middle Name
Salary Educational Attainment Religion

Mother
Maiden Name Age Occupation
Last Name, First Name, Middle Name
Salary Educational Attainment Religion

Guardian
Name Relationship Age
Last Name, First Name, Middle Name
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 Otherspls specify
6. Food production activities:
Home cooked Carendiria Fast food Otherspls 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:
http://depedtambayanph.blogspot.com/
_____________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
_________________________________________
Signature of Parent/ Guardian

http://depedtambayanph.blogspot.com/

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