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Home Visit Record11

The document is a Home Visit Record for Columbio Central Elementary School in the Philippines, detailing pupil and family information, including personal details, economic status, and living conditions. It includes sections for recording the pupil's scholastic standing and recommendations. The form requires signatures from the parent or guardian.

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ALBASIR KUSAIN
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11 views2 pages

Home Visit Record11

The document is a Home Visit Record for Columbio Central Elementary School in the Philippines, detailing pupil and family information, including personal details, economic status, and living conditions. It includes sections for recording the pupil's scholastic standing and recommendations. The form requires signatures from the parent or guardian.

Uploaded by

ALBASIR KUSAIN
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 XII
Division of Sultan Kudarat
Columbio District I
COLUMBIO CENTRAL ELEMENTARY SCHOOL
___________________________________________________________________________

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:

________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________
Republic of the Philippines
Department of Education
Region XII
Division of Sultan Kudarat
Columbio District I
COLUMBIO CENTRAL ELEMENTARY SCHOOL
___________________________________________________________________________

_________________________________________
Signature of Parent/ Guardian

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