Republic of the Philippines

Department of Education
Region VII – Central Visayas
TAGBILARAN CITY SCHOOLS DIVISION
Manga National High School
Tagbilaran City

HOME VISITATION FORM

Date: _______________
Time: _____________
I. STUDENTS PERSONAL INFORMATION
Name: ____________________________________________ Grade and Section: _____________________
Birthday: ____________________________________ Place of birth: _______________________________
Gender: ________________________________ Age: ________________
II. PURPOSE OF HOME VISIT
To discuss to the parents about the students’ habitual absences.
To address the student’s learning difficulties such as reading issues, numeracy issues, and writing issue.
To inform the parents about the students’ social behavior: involvement in school activity, bullying,
interaction towards his/her classmates, interaction towards his/her teachers.
To inform the parents about the student’s classroom and academic behavior: participation in
classroom discussion, conduct of performance task, submitting written output in each subject,
assessment progress in each subjects.
Others: ___________________________________________________________

III. WHO WAS PRESENT DURING THE VISITATION? ____________________________

IV. WHAT ISSUES WERE DISCUSSED AT THE HOME VISIT?

________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

V. RECOMMENDATIONS
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

CHRISTINE TIARA T. ZAMORA _________________________________

SECTION ADVISER/ TEACHER PARENTS PRINTED NAME & SIGNATURE

Noted by :

GRACE MARIE L. CAMPOS

Secondary School Principal I