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Jose de Villa National School: Home Visitation Form

The document is a home visitation form from the Jose de Villa National School in Camarines Sur, Philippines. It contains sections for documenting home visits conducted during the 2020-2021 school year, including the date, time, student and parent names, reason for the visit, and any resolutions or agreements made. There is also a separate dropping form that parents can sign to officially drop their child from the school. It lists several potential reasons for dropping out, including domestic, individual, school, geographic/environmental, and financial factors.

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Noli Asuro
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387 views

Jose de Villa National School: Home Visitation Form

The document is a home visitation form from the Jose de Villa National School in Camarines Sur, Philippines. It contains sections for documenting home visits conducted during the 2020-2021 school year, including the date, time, student and parent names, reason for the visit, and any resolutions or agreements made. There is also a separate dropping form that parents can sign to officially drop their child from the school. It lists several potential reasons for dropping out, including domestic, individual, school, geographic/environmental, and financial factors.

Uploaded by

Noli Asuro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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DEPARTMENT OF EDUCATION

Region V
Division of Camarines Sur
Jose de Villa National School
Manguiring, Calabanga, Camarines Sur

_______________________________________________________________________________________________

HOME VISITATION FORM


SY 2020-2021

------------------------
(Grade Level- Section)

Date : _________________________
Time : _________________________
Name : _________________________
Reason for Home Visitation : (Example only: Non-getting and submission of
modules
Difficulty in communicating with the learner as
well as the parents.
Remediation activity (Grade 9 back subject)
Attitude towards schooling
Other concerns)

Resolution and agreement between the parent/learner and the school

1. ________________________________________________________________________
__________________________________________________________________

2. ________________________________________________________________________
__________________________________________________________________

3. ________________________________________________________________________
__________________________________________________________________

4. ________________________________________________________________________
__________________________________________________________________

5. ________________________________________________________________________
__________________________________________________________________

Signed and Agreed by both parties:

____________________________ _____________________________
Parent’s name and signature over printed names Adviser’s name and signature over printed names
Parent’s Contact No. ____________________________

Witness name and Signature: ___________________________________________________


DEPARTMENT OF EDUCATION
Region V
Division of Camarines Sur
Jose de Villa National High School
Manguiring, Calabanga, Camarines Sur

_______________________________________________________________________________________________

DROPPING FORM
SY 2020-2021

I, ____________________________________________________, parent/guardian of
_____________________________________ of Grade ________(Grade& Section) am officially dropping out
my son/ daughter from this school, effective ____________________________due to the following reason/s:
(pls. check)

DOMESTIC-RELATED FACTORS Others: (specify)


_________ had to take care of siblings
_________ early marriage/pregnancy
_________ parents’ attitude toward schooling
_________ family problems

INDIVIDUAL-RELATED FACTORS
_________ illness
_________ overage
_________ death
_________ drug abuse
_________ poor academic performance
_________ lack of interest/distractions
_________ hunger malnutrition

SCHOOL-RELATED FACTORS
_________ teacher factor
_________ physical condition of classroom
_________ peer influence

GEOGRAPHIC/ENVIRONMENTAL
_________ distance between home and school/ change of residence
_________ armed conflict
_________ calamities and disasters

FINANCIAL RELATED
_________ child labor, work

Parent’s printed name and signature: ____________________________________


Attested by Adviser: __________________________________________

Noted:

____________________ ______________________
Year Level Adviser Secondary School Principal I

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