DepEd – LUTUCAN CENTRAL SCHOOL

Lutucan Malabag, Sariaya, Quezon

lutucancentral@gmail.com/(042) 525-7237

“Lead, Commit, and Serve”

 

ANECDOTAL RECORD
Home Visit Form
(Grade 2 – Malinis)
Date of Visit: _____________________

Name of Pupil: _______________________________________________________ Birth date:________________

Residence: ___________________________________________________________________

Father: ___________________________________________ Mother: _________________________________________

Occupation: _______________________________________ Occupation: _____________________________________

Educational Attainment:____ Elementary Educational Attainment:____ Elementary

____ High School ____ High School
____ Vocational ____ Vocational
____ College ____ College

No. of Children in the Family: _______ Boy: ____ Girl: ____ Living with Parents: Yes: ____ No: ____

State if both parents are living: _______ Yes: ____ No: ____ If no, pls. specify: __________________

Economic Status: ___Very Poor ___ Poor ___ Average ___ High

A. Academic Profile

1. Reading

Filipino 2 English 2
1 2 3 4 1 2 3 4
Non-Reader Non-Reader
Frustration Frustration
Instructional Instructional
Independent Independent

Legend: 1-Non Reader 2-Frustration 3-Instructional 4-Independent

(Please check appropriate box in each grade applicable opposite Nos. 1, 2, 3, or 4 and case may be.)

2. Mathematics

GRADE 2
1 2 3 4
Addition
Subtraction
Multiplication
Division

Legend: W- level of mastery is very poor X- some degree of mastery but needs more practice
Y- just enough mastery Z- manifest excellence
(Above code shall be entered for each of the curriculum year)

____________________________________________
Name & Signature of Person Contacted

Noted: HONEYLYN O. MANAHAN

Name of Adviser