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Republic of the Philippines

Department of Education
MIMAROPA Region
Schools Division of Occidental Mindoro
MAGSIKAP NATIONAL VOCATIONAL HIGH SCHOOL

HOME VISIT NO. ___________

HOME VISITATION AND GUIDANCE FORM

Student's Name
Grade/Year/Section Date of Birth:

1. Date of Home Visit:

2. Purpose/s of Home Visit:

3. Who was/were present during visitation?


4. Are the family's needs being met? (i.e. electricity, heat, hot water, food and clothing, etc?)

5. What issues were discussed at the home visit?

6. Were any recommendations/suggestions were given to parent/family?


a. What are they?

b. Who is/are responsible for follow up?

7. Next step
ACTION TARGET DATE RESPONSIBLE PERSON

Person Conducting Home Visit Conforme

ACCEPTED AND NOTED:


NATIVIDAD A. ESTOYA
Guidance Counselor Designate/Teacher II

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