Numele i prenumele:______________________________________________________________ Data naterii:______________________________________________________________________ Clasa:____________________________________________________________________________ Domiciliul:_______________________________________________________________________ II.
DATE DESPRE FAMILIE
Numele i prenumele prinilor:
- tata____________________________________________________________________________ - mama__________________________________________________________________________ Ocupaia i locul de munc: - tata____________________________________________________________________________ - mama__________________________________________________________________________ Frai/surori:_______________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ __ Atitudinea i/sau conduita prinilor fa de: - Copil:________________________________________________________________________ _____________________________________________________________________________ _ - rezultatele colare ale copilului:____________________________________________________ III.
DATE MEDICALE
Dezvoltarea somatic general:_______________________________________________________
________________________________________________________________________________ _ Starea actual de sntate:___________________________________________________________ IV.
DATE PSIHOLOGICE
C.I. (coeficientul de inteligen):______________________________________________________
1. Atenia Nivelul calitilor ateniei Stabilitate
Slab
Mediocr
Bun Foarte bun
Grad de concentrare Distributivitate Mobilitate Hiperactivitate cu deficit de atenie (A.D.H.D.): Da
Nu
2. Psihomotricitatea Slab dezvoltat
Mediocr
Normal/Bun
Motricitatea global Motricitatea fin Funcia perceptiv-motorie Organizare spaiotemporal Organizarea i structurarea spaiului grafic Instabilitate/agitaie psihomotorie: 3. Stil perceptiv:
Da
Nu
pripit-impulsiv
Analiza perceptiv:
haotic
lent-inert
echilibrat
relativ nesistematic
sistematic
4. Memoria Slab
Mediocr
Bun
Foarte bun
Memoria de lung durat
Memoria de lucru Memoria mecanic Memoria logic 5. Gndirea Nivelul de dezvoltare al operaiilor gndirii:
f. sczut
sczut
srac
mediu
mediocru
Funcionalitate gndirii este specific:
-
stadiului preoperaional
stadiul operaiilor concrete
stadiul preformal
6. Limbajul a) Limbajul verbal Volumul vocabularului: Pronunia:
f. srac
dislalie simpl
dislalie polimorf
bogat pronunie corect
bun
Exprimarea verbal:
greoaie/lent
b) Limbajul scris Lectura: corect/fluent Scrierea:
blbial
incorect gramatical
lent, cu poticniri
corect
disgrafie
fluent
dislexie
alexie
disortografie
agrafie
7. Afectivitatea Echilibru emoional Anxietate
Instabilitate emotiv
Labilitate afectiv
Agresivitate emoional-verbal
Rezisten la frustrare:
f. sczut
Agresivitate manifest
sczut
mare
8. Temperamentul Coleric
Sanguin
Flegmatic
9. Capacitatea de autoreglare Foarte redus 10. Mecanisme de copping: 11. Stima de sine Foarte sczut 12. Sociabilitate Foarte sczut
___________________________________________________________________________________ _ 14.Manifestri comportamentale negative:_______________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ __ V.
DATE PEDAGOGICE
1. Motivaia pentru activitile colare:
Foarte sczut Extrinsec
sczut
adecvat
predominant extrinsec
2. Prezena la activitile colare: foarte slab
3. Rezultatele la nvtur: f. slabe
slabe
crescut predominant intrinsec
slab mediocre
bun bune
f. bune
4. Stilul de nvare: __________________________________________________________________
5. Disciplinele colare la care are dificulti de nvare:____________________________________ ___________________________________________________________________________________ _ 6. Disciplinele colare la care are rezultate bune:__________________________________________ ___________________________________________________________________________________ _ 7. Atitudinea elevului fa de: - activitatea colar:___________________________________________________________________ _________________________________________________________________________ - personalul didactic: _______________________________________________________ - colegi:__________________________________________________________________ 8. Integrarea n colectivul clasei:_____________________________________________ _________________________________________________________________________ 9. Comportamentul n timpul activitilor didactice:___________________________ ___________________________________________________________________________________ _______________________________________________________________ 10. Opiunile elevului privind orientarea colar:______________________________ _________________________________________________________________________ 11. Recomandarea dirigintelui/psihopedagogului privind orientarea colar i profesional:________________________________________________________________________ _____________________________________________________________ Programe i activiti educative i corectiv-compensatorii: - Programe de stimulare cognitiv - Terapia tulburrilor de limbaj - Terapie cognitiv-comportamental - Altele______________________________________________________________
