Scribd
Upload
107 views1 page

Untitled

This document is an authority form from Tagum City National Comprehensive High School in the Philippines for a teacher to conduct a home visitation of a student. It contains the name of the teacher, student, and address to be visited, as well as the date, time and purpose of the visit. The form requires approval from the secondary school principal and certification from the parents that the home was visited. It provides space to document observations made during the visit such as distance from school, economic status, family relationships, and the family's views on education. Recommendations from the visit are also included.

Uploaded by

Genemar Tan Marte
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
107 views1 page

Untitled

This document is an authority form from Tagum City National Comprehensive High School in the Philippines for a teacher to conduct a home visitation of a student. It contains the name of the teacher, student, and address to be visited, as well as the date, time and purpose of the visit. The form requires approval from the secondary school principal and certification from the parents that the home was visited. It provides space to document observations made during the visit such as distance from school, economic status, family relationships, and the family's views on education. Recommendations from the visit are also included.

Uploaded by

Genemar Tan Marte
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
You are on page 1/ 1

Republic of Philippines

DEPARTMENT OF EDUCATION
Region XI
-oOo-
DIVISION OF TAGUM CITY
TAGUM CITY NATIONAL COMPREHENSIVE HIGH SCHOOL
(Formerly Davao National High School)
Mankilam, Tagum City
Tel Nos.: 084) 216-6492 Fax No.: (084) 216-6492

AUTHORITY TO CONDUCT HOME VISITATION


SY __________ - __________

Name of Teacher: ______________________________________________________________________


Name & Section of Student to be visited: ___________________________________________________
Home Address: ________________________________________________________________________
Purpose of Visitation: ___________________________________________________________________
Date & Time of Visitation: _______________________________________________________________

Requested by:
________________________________
Signature over Printed Name
Approved by:
ROGER A. MARTINEZ, MITE
Secondary School Principal IV
Visited Certifies by:
___________________________________________
Signature of Parents/Guardian over Printed Name

Home Visited for SY: _______________________________________


Name & Section of Student: _________________________________ Date: ______________

PROGRESS REPORT

Brief Summary of the interaction with the


Parent/Guardian and Student:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
______________________________________________________________________________
Other Observations:
A. Approximate Distance in Kilometers of Residence from School: _____________________________
B. Mode of Transportation: ____________________________________________________________
C. Economic Status
a. Source of Income: ___________________________________________________________
b. Number of Families in the Household: ___________________________________________
D. Family Relationship:
a. ( Intact/Separated/single Parent/Living with Relatives)
b. Working Student/ Working for the Family
E. Family’s Ideals/Philosophy/ in Education: _______________________________________________
____________________________________________________
RECOMMENDATIONS:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Prepared by:
________________________________________
Signature over Printed Name of Adviser/Teacher

You might also like