Department of Education

Region VI-Western Visayas

Division of Capiz
District of Ivisan
IVISAN NATIONAL HIGH SCHOOL

PARENT’S/GUARDIAN’S COMMUNICATION CARDEX

Name:________________________________ Parent Mother

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

Name of Student:__________________________________ Gender: Male Female

st nd
Grade and Section: ________________________________ Quarter: 1 2 3rd 4th
Name of Adviser: __________________________________

Date Reported Type of Encounter Details of Concern Agreed Resolution Signature

Dialogue Parent/Guardian:
Consultation
Home Visitation __________________
Assembly//Forum
Counseling with
the Guidance Teacher:
Counselor

Guidance Counselor:

__________________

Remarks:

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