Guidance Form.docx

Republic of the Philippines

Region I DIVISION OF LA UNION Balaoan District

PARAOIR ELEMENTARY SCHOOL

CASE REPORT ___________________ Date NAME: _________________________________________GRADE/SECTION: _____________ ADDRESS: __________________________________________________________________ PARENTS: ___________________________________________________________________ NATURE OF THE PROBLEM: (Emotional, Financial, Health, Spiritual, Family, Academics, etc.) ___________________________________________________________________________ INCEDENT: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ INTERVENTION/ACTION TAKEN: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________

_______________________________ Pupil’s Signature

___________________________ Parent/Guardian’s Signature

_______________________________ Adviser

___________________________ Guidance Teacher

ADELINO N. URBANO JR. District Instructional Supervisor

Guidance Form 3 Republic of the Philippines

Region I DIVISION OF LA UNION Balaoan District

PARAOIR ELEMENTARY SCHOOL ___________________ Date Dear Parent/ Guardian, May I invite you for a conference/important consultative meeting with the undersigned regarding your son/daughter, _______________________________________________ on ______________________________ for the following reason: (Date and Time) ____________________________ Tardiness ____________________________ Absences ____________________________ Academic Problem/s ____________________________ Behavioural Problem ____________________________ Others Please take your time to be with us. Thank you very much.

_____________________________________ Adviser

Noted: _____________________________________ School Head

LORNA B. PARTIBLE Guidance Coordinator