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Republic of The Philippines Department of Education: Home Visit Record

This document records information from a home visit, including the pupil's personal details, family members, economic status, scholastic standing, and recommendations. It documents the pupil's name, birthdate, gender, parents' names and occupations, siblings, home address, materials used for the house, available facilities, language spoken at home, food sources, fence type, and animal containment. It also notes the pupil's position in the family, financial status, scholastic performance, and recommendations from the visit.

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Rhoda Mhaye Balaoro Andallo
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47 views2 pages

Republic of The Philippines Department of Education: Home Visit Record

This document records information from a home visit, including the pupil's personal details, family members, economic status, scholastic standing, and recommendations. It documents the pupil's name, birthdate, gender, parents' names and occupations, siblings, home address, materials used for the house, available facilities, language spoken at home, food sources, fence type, and animal containment. It also notes the pupil's position in the family, financial status, scholastic performance, and recommendations from the visit.

Uploaded by

Rhoda Mhaye Balaoro Andallo
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 III
Schools Division of _________________________
_____________________________________ SCHOOL

HOME VISIT RECORD


Dat
e
Tim
e
I. Pupils Personal Information:
Nam
e
Last Name,
Middle Name

Nick Name

Grade

Date of Birth

Gender

First Name,

Place of Birth

II. Family Information:


Father
Age

Name
Last Name,

Salar
y

First Name,

Last Name,

Religion

Mother
Age
First Name,

Salar
y

Religion
Guardian
Relationshi
p

First Name,

Occupation

Occupatio
n

Middle Name

Educational
Attainment

Nam
e
Last Name,

Middle Name

Educational Attainment

Maiden
Name

Occupatio
n

Ag
e

Middle Name

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:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
_____________________________________________________________________________________________________

_________________________________________
Signature of Parent/ Guardian

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