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Republic of the Philippines

DEPARTMENT OF EDUCATION
Region X
Division of Lanao del Norte
Brgy. Pigcarangan, Tubod
Lanao del Norte, 9209

MANGA INTEGRATED SCHOOL

STUDENT ABSENTEESIM FORM


Student’s Name:_____________________________________ Date: ___________________
Year & Section: _____________________________________
Name of Parents/Guardian: ____________________________
____________________________

(Note to teacher/adviser: Prior to home visit, a letter must be given informing of the home visit. This
form must be accomplished in the presence of parents/guardian during home visit. Teacher/adviser
may use vernacular dialect to achieve accurate answers.)

QUESTION ANSWER
1. What time does the student fall asleep at
night? What time does the student usually
wake up in the morning?

2. How does the student go to school during


weekdays? (e.g., school service/sidecar,
walking, etc.)

3. How long does it usually take for the


student to get to school? (in minutes)

4. Is the student a working student? Does


he/she have any work obligations before
or after school hours?

5. Does the student have any medical


conditions that would sometimes hinder
him/her from attending school? (pls.
indicate if there is any)
(Note: Let the student answer on his/her own. Let him/her rate the question or statement; 3 for
AGREE, 2 for Neutral, 1 for DO NOT AGREE)

1 2 3
Question/Statement (DO NOT (NEUTRAL) (AGREE)
AGREE)
1. School/Education is important.

2. I am interested in learning from


my teachers in school.
3. I enjoy going doing school
activities.
4. I enjoy going to school and
meeting my classmates every
weekdays.
5. I have my own goals for my future
career.

If there are any other reasons for the frequent tardiness and absences of the students, what are
these?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Signed by:

Norvel H. Alilangan
School Principal

_______________________________ ______________________________
Adviser Parents/Guardian
(name over signature) (name over signature)