Republic of the Philippines

Department of Education
Caraga Region XIII
Division of Agusan del Norte
Carmen District 1
Carmen National High School
Carmen, Agusan del Norte

PARENT-TEACHER COMMUNICATION INDEX

Name: ___________________________________________ □ Parent □ Mother

Address : _________________________________________ □ Father
Contact No.: ______________________________________ □ Guardian □ Relative
□ Other (Specify)
Name of Student: __________________________________ Gender: □ Male □ Female
Grade & Section: __________________________________ Quarter: □ 1st □ 2nd □ 3rd □ 4th
Name of Adviser: __________________________________ School Year: ________________________

Date
Type of Encounter Details of Concern Agreed Solutions Signature
Reported
□ Dialogue Parent/Guardian:
□ Consultation
□ Home Visitation
□ Assembly/Forum

Teacher:

□ Dialogue Parent/Guardian:
□ Consultation
□ Home Visitation
□ Assembly/Forum

Teacher:

□ Dialogue Parent/Guardian:
□ Consultation
□ Home Visitation
□ Assembly/Forum

Teacher:

Remarks:
 Republic of the Philippines
Department of Education
Caraga Region XIII
Division of Agusan del Norte
Carmen District 1
Carmen National High School
Carmen, Agusan del Norte

STUDENT-TEACHER COMMUNICATION INDEX

Name: ___________________________________________ Gender: □ Male □ Female

Address: _________________________________________
Name of Parent/Guardian: ____________________________________ Contact No.: __________________
Grade & Section: __________________________________ Quarter: □ 1st □ 2nd □ 3rd □ 4th
Name of Adviser: __________________________________ School Year: ________________________

Date
Type of Encounter Details of Concern Agreed Solutions Signature
Reported
□ Dialogue Student:
□ Consultation
□ Home Visitation
□ Assembly/Forum

Teacher:

□ Dialogue Student:
□ Consultation
□ Home Visitation
□ Assembly/Forum

Teacher:

□ Dialogue Student:
□ Consultation
□ Home Visitation
□ Assembly/Forum

Teacher:

Remarks: