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Home Visitation Form

The document is a Home Visitation Form used by Palao Elementary School in Lanao del Norte for documenting visits to learners' homes. It includes sections for the purpose of the visit, learning materials provided, challenges identified, parental feedback, and follow-up actions needed. The form is designed to support the academic progress of students and address any issues they may face.

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JADE DINGCO
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1 views

Home Visitation Form

The document is a Home Visitation Form used by Palao Elementary School in Lanao del Norte for documenting visits to learners' homes. It includes sections for the purpose of the visit, learning materials provided, challenges identified, parental feedback, and follow-up actions needed. The form is designed to support the academic progress of students and address any issues they may face.

Uploaded by

JADE DINGCO
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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Department of Education

Region X, Northern Mindanao


Division of Lanao del Norte
Tubod East District
PALAO ELEMENTARY SCHOOL

Home Visitation Form

Name of Learner: __________________________________________


Grade Level/Section: _____________________________________
Date of Visitation: _______________________________________

Details of Visitation

Purpose of Visit:
☐ Distribution of Learning Materials
☐ Follow-Up on Learner's Academic Progress
☐ Addressing Challenges in Learning
☐ Other: ________________________________________________

Learning Materials Provided:

 Subject(s): ______________________________________________
 Type of Materials (e.g., worksheets, books, activity guides)

Remarks/Observations:

Challenges or Issues Identified:


☐ Lack of Learning Materials
☐ Limited Parental Support
☐ Connectivity Issues
☐ Others: _______________________________________________

Parental/Guardian Feedback
Parent/Guardian Name: _____________________________________
Contact Number: ___________________________________________
Feedback on Learning Support:

Follow-Up Actions Needed:


☐ Conduct Additional Home Visit
☐ Provide Tutorial Support
☐ Address Specific Concerns: _______________________________
☐ Others: _________________________________________________
Name of Visiting Teacher: __________________________________

Signature: ____________________________

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