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Republic of the Philippines

Department of Education
REGION IX- ZAMBOANGA DEL SUR
Division of Zamboanga del Sur

LAPUYAN NATIONAL HIGH SCHOOL

PARENT’S/GUARDIAN’S COMMUNICATION CARDEX

Name of Parent/s:_____________________ ☐ Parent ☐ Mother


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

Name of Student: ____________________ Gender: ☐ Male ☐ Female


Grade and Section: __________________ Quarter: ☐ 1st ☐ 2nd ☐ 3rd ☐ 4th
Name of Adviser: ____________________

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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