CENTRUL COLAR

PENTRU EDUCAIE INCLUZIV

TRGU LPU

FIA VIZITEI LA DOMCILIUL ELEVULUI

Numele i prenumele profesorului diriginte: _________________________________
Numele i prenumele elevului: ___________________________________; Clasa _______
Domiciliul elevului: _________________________________________________________
Nr. de telefon al mamei: _____________ ; Nr. de telefon al tatlui: _____________
Data vizitei: ____________
Tata (numele i prenumele):___________________________
Mama (numele i prenumele):__________________________
Numrul frailor elevului: __________
Numrul membrilor familiei care locuiesc n aceeai gospodrie cu elevul: _________
Locul de munc al tatlui: ____________________________________________________
Locul de munc al mamei: __________________________________________________
(dac prinii lucreaz n strintate se va specifica doar ara)
Observaii privind membrii familiei (copii minori, coala la care sunt nscrii, probleme de
sntate etc. orice alte informaii considerate utile privind membrii familiei ): _____________
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Observaii privind locuina elevului (condiii de locuit, suprafa, utiliti etc.): _____________
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Venitul mediu lunar al familiei (salarii, pensii, alocaii, alte venituri): _________________.
Alte observaii: ________________________________________________________________
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Semntura profesorului diriginte
Semntura printelui
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Trgu-Lpu, Str. Piaa Eroilor, nr. 31
Tel/fax 0262384462,
e-mail: specialatgl@yahoo.com