Republic of the Philippines

Department of Education
REGION VIII
SCHOOLS DIVISION OFFICE OF LEYTE
PALO I DISTRICT
GACAO ELEMENTARY SCHOOL
121741

HOME VISITATION FORM

I. Pupil’s Personal Information Date: _____________________

Time: ____________________

Name: ________________________________________ Grade & Section: _______________________________

Place of Birth: __________________________________ Date of Birth: _________________ Gender: _________

II. Purpose of Home Visitation

To discuss to the parents about their To address their children’s learning difficulties
involvement in the new normal such as reading issue, math issue and writing
issue

To identify the learner’s performance in their

class home

III. Who was present?

Father Elder Brother/ Sister

Mother Grand Parents

IV. What issues were discussed at the home visit?

Learner’s Health
Help Parents Tutor Son/ Daughter
Help Parent Receive Assistance
Purpose of return visit
Other Resources

V. Recommendations:

Keep updates on group chat/messenger Have good conversation

Provide printed information to parents on Comment classroom learning to the home
policies and on monitoring and supporting by assigning “ healthy homework” reinforce
learner work at home the importance of healthy eating and
Attend / Join virtual : Kumustahan” physical activity.
Provide learning materials to parents on
how to improve children’s study skills or learning in
various academic subjects
Approach/ Message teacher when you need

_______________________________________ _______________________________________
TEACHER SIGNATURE OF PARENTS/GUARDIANS