ED 428 Preschool Student Teaching Home Visit Documentation Sheet

Child:_______________________ Completed By:________________

1st Visit

Date:

Purpose of visit:

Information shared by parents:

Information shared with parents:

Parent Signature:___________________________________ Date:_____________

2nd Visit

Date:

Purpose of visit:

Information shared by parents:

Information shared with parents:

Parent Signature:___________________________________ Date:_____________

3rd Visit

Date:

Purpose of visit:

Information shared by parents:

Information shared with parents:

Parent Signature:___________________________________ Date:_____________