Republic of the Philippines

Department of Education
Region VII, Central Visayas
Division of Cebu City
North District 6
ZAPATERA NATIONAL HIGH SCHOOL

HOME VISITATION FORM

Name of Student_______________________________ LRN ________________ Grade/Section ____________

Address ______________________________________ Birthdate____________Gender_________ Age_______
Name of Father ____________________________________ Contact Number _________________________
Name of Mother ____________________________________ Contact Number ________________________

REASON/S FOR HOME VISITATION:

______________________________________________________________________________________
______________________________________________________________________________________
____________________________________________________________________________.

REMARKS/AGREEMENT:

_________________________________________ _______________________________________
PARENT’S/ GUARDIAN SIGNATURE OVER PRINTED NAME STUDENT’S SIGNATURE OVER PRINTED NAME

Prepared by: NOTED:

________________________________ CINDY O. PERIGO EdD

Class Adviser Principal II
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
Division of Cebu City
North District 6
ZAPATERA NATIONAL HIGH SCHOOL

SULAT PAHIBALO

Petsa: ___________________

Tinahud nga Magtutudlo:

Ako si ________________________________ ginikanan/ guardian ni ____________________________

(pangalan sa ginikanan/guardian) (pangalan sa estudyante)
nga nagatungha sa ZAPATERA NATIONAL HIGH SCHOOL DAY/NIGHT Session _______________ni tugot sa
(Grade & Section)
desisyon sa akong anak nga moundang sa pag-eskwela karun nga school year __________________
tungod sa kasamtangang rason
nga___________________________________________________________________________________
________________________________________________________. (Isugilon ang rason nga niundang)

Naghinaot sa tumang pagsabot ug Daghang Salamat!

Kanimo mabinati-on,

_________________________________
(Pangalan ug Pirma sa Ginikanan/ Guardian)

Attested by:

___________________________________________

Class Adviser
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
Division of Cebu City
North District 6
ZAPATERA NATIONAL HIGH SCHOOL

SULAT KASABUTAN

Petsa: ___________________

Tinahud nga Magtutudlo:

Ako si ________________________________ ginikanan/ guardian ni ____________________________

(pangalan sa ginikanan/guardian) (pangalan sa estudyante)

nga nagatungha sa ZAPATERA NATIONAL HIGH SCHOOL DAY/NIGHT Session _______________ni saad sa
(Grade & Section)
Pag follow-up/ atiman sa akong bata nga motubag gayod sa gihatag nga mga “Enrichment Activities”
aron makakuha sa sakto nga grado/ rating matag asignatura (subject) sigun sa giladga sa DepEd. Ug
nagasad nga mosumite niini sa gikasabutan nga petsa.

Petsa sa pag sumite sa mga gihatag nga mga gimbuhaton. _____________________________________

Naghinaot sa tumang pagsabot ug Daghang Salamat.

Kanimo mabinati-on,

_________________________________
(Pangalan ug Pirma sa Ginikanan/ Guardian)

Attested by:

___________________________________________

Class Adviser
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
Division of Cebu City
North District 6
ZAPATERA NATIONAL HIGH SCHOOL

LIST OF LEARNERS TO BE GIVEN WITH ENRICHMENT ACTIVITIES

IN
_____________
2022-2023

Name of Learner No. of Activities Signature

Prepared by: Noted:

JHUN KEVIN G. DICHOSA CINDY O. PERIGO EdD

Subject Teacher School Principal
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
Division of Cebu City
North District 6
ZAPATERA NATIONAL HIGH SCHOOL

Date:______________

____________________
____________________
____________________

To whom It May Concern:

Greetings…
This is to inform you that the teachers of our school, Zapatera National High School are going to
conduct a home visitation for learners in your barangay who need assistance in their studies for the
following reasons, such as:
** Late submission of outputs
** Low scores in their tasks
** Inactive participation in school activities
** Informing the parents/ guardians on learners’ status
Remedies:
** Giving of modules
** Providing of competencies aligned remedial/ enrichment/ supplemental activities
** Writing of agreement (agreed schedule of submission and other solutions
** Conducting of remedial classes (with memorandum of agreement)
See attached list for home visitation.

We appreciate it very much for the support given to the school.

Prepared by: Noted:

____________________ CINDY O. PERIGO EdD
Class Adviser Principal
 Republic of the Philippines
Department of Education
Region VII, Central Visayas
Division of Cebu City
North District 6
ZAPATERA NATIONAL HIGH SCHOOL

LIST OF LEARNERS FOR HOME VISITATION

__________________
(Barangay)

NAME OF LEARNER NAME OF PARENT/ CONTACT NO. SITIO

GUARDIAN

Prepared by: Noted:

____________________ CINDY O. PERIGO EdD

Class Adviser Principal