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    Intake Sheet Enclosure A

    Uploaded by

    Maria Luisa Maycong
    The document is an intake sheet for the Department of Education that collects information about a victim, complainant, and respondent related to a case. It requests names, dates of birth, addresses, occupations, and other identifying information about the victim, complainant, and respondent. If the respondent is a school personnel or student, it collects additional details. The sheet also has sections to document details of the case, actions taken, and recommendations.

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    © All Rights Reserved
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    Intake Sheet Enclosure A

    Uploaded by

    Maria Luisa Maycong
    1K views2 pages
    The document is an intake sheet for the Department of Education that collects information about a victim, complainant, and respondent related to a case. It requests names, dates of birth, addresses, occupations, and other identifying information about the victim, complainant, and respondent. If the respondent is a school personnel or student, it collects additional details. The sheet also has sections to document details of the case, actions taken, and recommendations.

    Original Description:

    Intake Sheet For Student at Risk

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    © © All Rights Reserved

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    The document is an intake sheet for the Department of Education that collects information about a victim, complainant, and respondent related to a case. It requests names, dates of birth, addresses, occupations, and other identifying information about the victim, complainant, and respondent. If the respondent is a school personnel or student, it collects additional details. The sheet also has sections to document details of the case, actions taken, and recommendations.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    1K views2 pages

    Intake Sheet Enclosure A

    Uploaded by

    Maria Luisa Maycong
    The document is an intake sheet for the Department of Education that collects information about a victim, complainant, and respondent related to a case. It requests names, dates of birth, addresses, occupations, and other identifying information about the victim, complainant, and respondent. If the respondent is a school personnel or student, it collects additional details. The sheet also has sections to document details of the case, actions taken, and recommendations.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Enclosure A-1

    Annex “B”

    Department of Education

    INTAKE SHEET

    I. INFORMATION:
    A. VICTIM:

    Name: _____________________________________________
    Date of Birth: __________________________ Age: __________ Sex: ___________
    Gr. /Yr. and Section: __________________ Adviser: ____________
    Parents:
    Mother: _______________________ Age: _______
    Occupation: ____________________
    Address: _______________________
    Father: ________________________ Age: _______
    Occupation: ____________________
    Address and Contact Number: __________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________

    B. COMPLAINANT:
    Name: ____________________________________________________
    Relationship to Victim: ___________________________________
    Address and Contact Number: _________________________________________________________
    _____________________________________________________________________________________
    _______________________________________________________________________________

    C. RESPONDENT:
    C-1. If respondent is a School Personnel
    Name: _____________________________________________________
    Date of Birth: ___________________________ Age: ________________ Sex: ________________

    Designation/Position: __________________________________
    Address and Contact Number: __________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    C-2. If respondent is a Student
    Name: ________________________________________________
    Date of Birth: __________________________ Age: _____________ Sex: _____________
    Gr. /Yr. and Section: ____________________ Adviser: ______________
    Parents/Guardian:
    Mother: ______________________________ Age: __________
    Occupation: ______________________
    Address and Contact Number: __________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    Father: ______________________________ Age: __________
    Occupation: ___________________________
    Address and Contact Number: __________________________________________________
    ___________________________________________________________________________
    ___________________________________________________________________________
    II. DETAILS OF THE CASE:
    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _____________________________________________________________________________________
    _____________________________________________________________________________________

    III. ACTION TAKEN:


    1.
    2.
    3.
    4.

    IV. RECOMMENDATIONS:
    1.
    2.
    3.

    Prepared By:

    _____________________________
    Name over Printed Name

    _____________________________
    Designation

    _____________________________
    Date

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