HOME VISIT FORM – QUALITATIVE INFORMATION

(To be filled out once a year for each sponsored child)

ID #: ___________________
Name of child:_____________________________ Year: _____________
Birth Date: _____________
Cost Centre: _____________________ Community: ______________________

I. SPIRITUAL DEVELOPMENT

1. Is the child receiving any teaching that helps him/her to know and trust God more?

2. What changes have the teachings about Jesus produced in the life of the child (on the level of his/her
beliefs, values and behaviour)?

II. INTELLECTUAL DEVELOPMENT

1. Have you observed any progress in the child in regards to his/her basic abilities for language (i.e
writing and reading) and for his/her learning in Math (i.e.-mathematical ratiocination, mathematics,
etc.)?

2. Is the child obtaining satisfactory grades in school? Is he/she receiving support from his/her parents?
Is there any factor that prevents the child from achieving his/her basic educational development?

3. Have you been able to identify the natural talents and abilities of the child (i.e. musical, artistic,
analytical, vocational, etc.) How has the child developed these talents and abilities?

SOCIAL DEVELOPMENT

1. What is the opinion of the parents about their child?

2. Is the child helping at home with a good attitude? (i.e. to help with the housework, to help his/her
siblings)? How is it evidenced?

3. Has the child evidenced willingness to help his/her friends of his/her community whenever he/she is
asked for help? How?
4. What are the child’s recreational opportunities? With whom does he/she share his/her recreation
time?

EMOTIONAL DEVELOPMENT

1. Does the child have an appropriate self-esteem? How is it evidenced?

2. What is the family environment of the child? Is there any factor that is influencing his/her emotional
development in a positive or negative way? (I.e. the child receives ongoing encouragement on part of
his/her parents, or if he/she is victim of any kind of abuse?)

PHYSICAL DEVELOPMENT

1. Is the child meeting his basic needs (adequate/balanced diet according to his/her age, clean water,
clean housing, medical attention in case of illness?

2. Have you observed if the child knows and practices basic principles of personal hygiene? How?

3. What is the attitude demonstrated by the child towards the cleanliness and care of his/her community
environment? What were the actions taken?

4. During the past six months, has the child suffered from any sickness or serious accident? What was
the problem and how was it dealt with?

GENERAL OBSERVATION

III. RECOMMENDATION

FHI/PERU
June 2000