小学家访记录表.pdfVIP

小学家访记录表

学校名称___________________________年级班级________年级________班

_____

学生姓名________________________性别□男□女

出生日期____年____月____日家访日期____年____月____日____时

____分

家访方式□上门走访□电话家访□视家访教师________________________

频家访□其他：________

家庭住址________________________________________________________

参与家访家长□父亲□母亲□祖父□祖母家长联系电话________________________

□其他监护人：________

家访原因□例行家访□学生表现突出□学习成绩波动□行为习惯问题

□心理健康关注□家校沟通需求□其他原因：________________________

一、学生在校情况摘要

1.学习情况：________________________________________________________

____________________________________________________________________

2.品德行为：________________________________________________________

____________________________________________________________________

3.人际关系：________________________________________________________

____________________________________________________________________

4.特长与优势：______________________________________________________

____________________________________________________________________

5.存在的主要问题：__________________________________________________

____________________________________________________________________

二、学生家庭情况与在家表现

1.家庭基本情况：____________________________________________________

____________________________________________________________________

2.在家学习情况：____________________________________________________

____________________________________________________________________

3.在家行为表现：____________________________________________________

____________________________________________________________________

4.家长教育方式：____________________________________________________

________________________________