Parent/Teacher Home Visits Participation Form
This form must be filled out for every visit. This is the form used to track visits for payment of stipends
LAST Name *
Your answer
FIRST Name *
Your answer
Your Employee ID Number *
Your answer
School *
Schools are listed in alphabetical order by type of school
Your position *
You role during the visit *
There should be two visitors on each visit. One should be the "main" visitor, the other is the "second" on the visit.
Who was your partner on this visit? *
Your answer
Did you attend the required parent teacher home visit training session? *
First and last name of student visited *
Your answer
Family's Ethnicity *
Date of visit
MM
/
DD
/
YYYY
Time
:
Which Debrief Session do you plan to attend?
Remember: for the semester you are visiting, you MUST attend a debrief session to receive your stipend. Register on PDexpress
Parent's Hopes and Dreams *
What were the parents' hopes and dreams for their child?
Your answer
What did I learn? *
What did you learn about the student or their interests that will help you in teaching him or her?
Your answer
Any comments about this visit?
Your answer
Visits that occur during your contracted work day are not compensated. If visit occurred during your contracted work day, check the box below.
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