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Home Visit Record: I. Pupil's Personal Information

This home visit record summarizes a student's personal and family information. It includes the student's name, date of birth, parents' names and occupations, number of siblings, and the family's economic status. Details provided include type of housing, materials used, appliances and facilities owned, languages spoken at home, and food production activities. The record concludes with sections on the student's scholastic standing and recommendations.

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54 views2 pages

Home Visit Record: I. Pupil's Personal Information

This home visit record summarizes a student's personal and family information. It includes the student's name, date of birth, parents' names and occupations, number of siblings, and the family's economic status. Details provided include type of housing, materials used, appliances and facilities owned, languages spoken at home, and food production activities. The record concludes with sections on the student's scholastic standing and recommendations.

Uploaded by

nelsbie
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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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 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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