<p> GLEAMNS Human Resources Commission, Inc. Post Office Box 1326 Greenwood, South Carolina 29648 Telephone: (864) 223-8434 Telefax: (864) 229-8857</p><p>Home Visit Report</p><p>Child’s Name: ______Center: ______</p><p>Address: ______</p><p>Telephone: ______Purpose of Visit: ______</p><p>Date/Time: ______Relationship to Child: ______</p><p>Others Present: ______</p><p>1. Report of child’s progress in cognitive, language, emotional, physical, and social development.</p><p>2. Suggestions for home learning activities:</p><p>3. Parent’s input to the educational program:</p><p>4. Other comments or observations:</p><p>This is to verify ______was in my home on ______,</p><p>______for the purpose of conducting a home visit.</p><p>______Parent’s Signature Staff Member’s Signature</p><p>GREENWOOD-LAURENS-EDGEFIELD-ABBEVILLE-MCCORMICK-NEWBERRY-SALUDA (Serving: Fairfield, Lexington, and Richland Counties)</p><p>“AN EQUAL OPPORTUNITY EMPLOYER”</p>