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Guidance forms
This document contains several forms used by Pasolo Elementary School. Form 1 is a pupil profile that collects personal information about students. Form 2 contains anecdotal records where teachers can record observations of students. Form 4 is a home visitation form documenting reasons for and notes from meetings with parents. Form 5 is a promissory note where students commit to improving behaviors. Form 6 includes a referral slip for students to meet with the guidance coordinator and a return slip confirming appointments.
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Guidance forms
- 1. FORM 1: __________________________________________________________________________________________________ Pupil’s Profile Name: ____________________________________________________________________________ (Last Name, First Name, Middle Name, Extension Name) Birthday : __________________________________________________ Age : _______________ Birthplace: __________________________________________________________________________ Religion : ___________________________________________________________________________ Address : __________________________________________ _________________________________ Barangay : ___________________________________________________________________________ Father’s name : ______________________________________________________________________ (Last Name, First Name, Middle Name, Extension Name) Educational Attainment: (Please check) ______Elementary ______ High School _______ College Occupation : __________________________________ Contact no. : ___________________________ Mother’s name (before marriage) : ____________________________________ ____________________ (Last Name, First Name, Middle Name, Extension Name) Educational Attainment: (Please check) ______Elementary ______ High School ___/___ College Occupation : ________________________________Contact no. : _____________________________ Guardian’s name : _____________________________________________________________________ (If not with parents) (Last Name, First Name, Middle Name, Extension Name) Contact no. : _______________________________________________ Date of entry (Grade IV) : ___________________________________________________________________ 4Ps / CCT recipient - Yes _______ No __________ Pasolo Road, Pasolo Valenzuela City Telefax: 293-30-83 Email:pasolo.elementaryschool@gmail.com Division of City Schools – Valenzuela Valenzuela North District PASOLO ELEMENTARY SCHOOL
- 2. FORM 2: __________________________________________________________________________________________________ ANECDOTAL RECORDS Teacher/Observer:__________________________________________ObservationTime:_______________________ ObservationDate:________________________ StudentName:________________________________________________ Descriptionof the incident:____________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Descriptionof the location/setting:___________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Recommendation/Actions: ____________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ _________ __________________ Guidance Coordinator Pasolo Road, Pasolo Valenzuela City Telefax: 293-30-83 Email:pasolo.elementaryschool@gmail.com Division of City Schools – Valenzuela Valenzuela North District PASOLO ELEMENTARY SCHOOL
- 3. FORM 2: __________________________________________________________________________________________________ ANECDOTAL RECORDS Guro/Observer:____________________________________________Oras:____________ ______________________ Petsa:__________________________________ Pangalanng Mag-aaral:________________________________________________ Mga Pangyayari:____________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ Paglalarawan saLugar at Tagpuan:___________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ RekomendasyonatAksyon: ___________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ _________ __________________ Guidance Coordinator Pasolo Road, Pasolo Valenzuela City Telefax: 293-30-83 Email:pasolo.elementaryschool@gmail.com Division of City Schools – Valenzuela Valenzuela North District PASOLO ELEMENTARY SCHOOL
- 4. FORM 4: ________________________________________________________________________ HOME VISITATIONFORM Name of Student___________________________. LRN ___________________Grade/Section _____________ Address____________________________________Birthday________________Gender___________ Age _______ Name of Father________________________________ Contact Number___________________________________ Name of Mother ______________________________ ContactNumber___________________________________ REASON FOR HOME VISITATION: ___________________________________________________________________________________________ __________________________________________________________________________________________________ _________________________________________________________________________________________ REMARKS/AGREEMENT: __________________________________________________________________________________________________ __________________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________ ________________________________ PARENT’S SIGNATURE OVER PRINTED NAME STUDENT’S SIGNATURE OVER PRINTED NAME Notedby: _________________________ Guidance Teacher Preparedby: _____________________ Adviser APPROVED: ________________________________ Guidance Coordinator Division of City Schools – Valenzuela Valenzuela North District PASOLO ELEMENTARY SCHOOL Pasolo Road, Pasolo Valenzuela City Telefax: 293-30-83 Email:pasolo.elementaryschool@gmail.com
- 5. FORM 4: ________________________________________________________________________ HOME VISITATIONFORM Pangalanng Mag-aaral_________________________. LRN ___________________Baitang/Pangkat:_____________ Tirahan____________________________________Kaarawan_______________Kasarian______________Edad _______ Pangalanng Ama________________________________ Contact Number___________________________________ Pangalanng Ina__________________________________Contact Number___________________________________ MGAKADAHILAN NG PAGBISITA SA MAG-AARAL: ___________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ KASUNDUANNG MGA MAGULANG NG MAG-AARAL AT GURONG TAGAPAMATNUBAY: __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ __________________________________________________________________________________________________ _________________________________ ________________________________ PANGALAN NG MAGULANG/LAGDA PANGALAN NG BATA Inihandani: ___________________________ Gurong Tagapayo BinigyangPansin: ____________________________________ Guidance Coordinator Division of City Schools – Valenzuela Valenzuela North District PASOLO ELEMENTARY SCHOOL Pasolo Road, Pasolo Valenzuela City Telefax: 293-30-83 Email:pasolo.elementaryschool@gmail.com
- 6. FORM 5: ________________________________________________________________________ PROMISSORY NOTE __________________ Petsa SaKinauukulan, Akosi _____________________________________, Baitang______ Pangkat____________________ na (Pangalan ng Mag-aaral) nasa ilalimngpamamahalani _____________________________________________ ay nangangakona hindi namuling ( Guro) __________________________________________________________________________________________________ __________________________________________________________________________________________________ (Mga Pagkakamaling Nagawa / Kahinaan ng Bata) at ________________________________________________________________________________________________ __________________________________________________________________________________________________ (Mga pangakong gagawin/Mga pagbabago) ___________________ ______________________ Pangalanng Magulang Pangalan ng Mag-aaral _____________________ Gurong Tagapamatnubay Binigyang – pansin: ___________________________ Guidance Coordinator Division of City Schools – Valenzuela Valenzuela North District PASOLO ELEMENTARY SCHOOL Pasolo Road, Pasolo Valenzuela City Telefax: 293-30-83 Email:pasolo.elementaryschool@gmail.com
- 7. FORM 6: _____________________________________________________________________ REFERRAL SLIP _________________ Date To the Guidance Coordinator, Please interview _____________________________________________Grade_____ Section____________. Chief reason/s for interview_______________________________________________________________________. Interviewrequested by: __________________________ Adviser FORM 6: _____________________________________________________________________ RETURN SLIP _______________ Date ____________________________, Interview with __________________________________________ will be on ________________________ at __________________.Please send the above child with his/her parent/s to the Guidance Office on time. __________________________ School Guidance Coordinator Division of City Schools – Valenzuela Valenzuela North District PASOLO ELEMENTARY SCHOOL Pasolo Road, Pasolo Valenzuela City Telefax: 293-30-83 Email:pasolo.elementaryschool@gmail.com Division of City Schools – Valenzuela Valenzuela North District PASOLO ELEMENTARY SCHOOL Pasolo Road, Pasolo Valenzuela City Telefax: 293-30-83 Email:pasolo.elementaryschool@gmail.com