Republic of the Philippines

Department of Education
REGION I – Ilocos Region
Division of Vigan City

ILOCOS SUR NATIONAL HIGH SCHOOL

PARENT’S/GUARDIAN’S COMMUNICATION CARDEX

Name: Maria Josepha Clara ☒ Parent ☒ Mother

☐ Father
Address: ____________________________ ☐ Guardian ☐ Relative
☐ Other (Specify)
Contact Number: _____________________

Name of Student: Maria Clara Gender: ☐ Male ☒ Female

Grade and Section: 11-Chrysolite Quarter: ☒ 1st ☐ 2nd ☐ 3rd ☐ 4th
Name of Adviser: Richard R. Raqueño

Date Reported Type of Encounter Details of Concern Agreed Resolution Signature

☒ Dialogue Regarding Mr. Clara’s It has been agreed Parent/Guardian:
☐ Consultation daughter observable upon that the
☐ Home Visitation decline in MMaria's student will be __________________
☐ Assembly//Forum class participation academically
compared to her assisted by
performance in the first teachers. Teacher:
two weeks due to Amicable agreement
social media bullying has been
__________________
and conflict with deliberated among
another student. the students
involved.

Remarks:

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