Republic of the Philippines

Department of Education
Region X
YUMBING NATIONAL HIGH SCHOOL
Yumbing Mambajao, Camiguin
S.Y 2019-2020

HOME VISITATION SLIP

The School Principal

Madam:

The undersigned would like to request permission to conduct home visitation to_________________
________________ on _________________ at ________________________________________________
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Very truly yours,

_______________________________
Class Adviser

Date filed: ______________________

Action taken

Approved
Disapproved

LIEZL A. OCLARIT
Secondary School Principal I
 Republic of the Philippines
Department of Education
Region X
YUMBING NATIONAL HIGH SCHOOL
Yumbing, Mambajao, Camiguin
S.Y 2019-2020

TEACHER’S HOME VISITATION GUIDE

Name of Teacher : ___________________________________________

Advisory Class/Year : ___________________________________________
Date of Visitation : Month __________ Date ___________ Year ____________

Person to be visited : __________________________________________________

Purpose of visitation : ________________________________________________________________
________________________________________________________________.

Issues To Be Resolved: ________________________________________________________________

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Findings: ________________________________________________________________
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Agreements Reached: ________________________________________________________________

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__________________________ __________________________ __________________________

Name & Signature of the Student Name & Signature of the Parent Name & Signature of the Adviser
 Republic of the Philippines
Department of Education
Region X
YUMBING NATIONAL HIGH SCHOOL
Yumbing,Mambajao, Camiguin
S.Y 2019-2020

NEIGHBOR/THIIRD PARTY VERIFICATION SHEET

RESPONDENT’S INFORMATION (To be filled up by the visiting teachers/adviser)

Name of Student : _______________________________________________________
Name of Parent/Guardian : _______________________________________________________
Year Level : _______________________________________________________
Date of Absenteeism : _______________________________________________________

Date of Visit : _______________________________________________________

Name of Neighbor or Third Party: _______________________________________________________
Address : _______________________________________________________

ISSUE/CONCERN NEIGHBORS/ THIRD PARTY’S

(Reasons of Non-attendance or Absenteeism
Cited by the respondent, please enumerate)
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VERIFICATION
(Remarks)
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 Republic of the Philippines
Department of Education
Region X
YUMBING NATIONAL HIGH SCHOOL
Yumbing, Mambajao, Camiguin
S.Y 2019-2020

BARANGAY COUNCIL REFERRAL SLIP

_____________________
Date

The Hon. ________________________________

Chairman/Committee on Education
Barangay: ________________________________

Sir/Madam:
We wish to inform your office that upon conducting a series of home visitation of one of the student/s
of Yumbing National High School in the person of _____________________________ who is a resident of
this Barangay was found out that
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Very truly yours,

_________________________________
Class Adviser/Teacher

Noted:

__________________________________
Chairman/Committee on Education