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FI DE INTERVENIE PSIHOPEDAGOGIC

DATE PERSONALE:
Nume i prenume:________________________________________________________
Apelativ:_________________Data naterii:_____________Locul naterii:____________
Adresa:_________________________________________________________________
Nr. telefon:______________________E-mail:__________________________________
Data lurii n eviden:_________Vrsta n momentul lurii n eviden:______________
Motivul pentru care s-a prezentat la cabinetul de consiliere:________________________
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Persoana care a fcut solicitare de consiliere:____________________________________
SITUAIA FAMILIAL:
Mama:
Nume i prenume:______________________Vrst:_________________
Ocupaia i locul de munc:_____________________________________
Tata:
Nume i prenume:________________________ Vrst:______________
Ocupaia i locul de munc:_____________________________________
Prinii:_______________(separai/divorai/decedai/plecai n strintate/prini vitregi)
Observaii:_______________________________________________________________
Frai: (nume/vrst/ocupaie)
__________________________________________________________________
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Observaii:_______________________________________________________________
SITUAIA COLAR:
Instituia de nvmnt: ____________________________________________________
Clasa: ___________________ Diriginte(nume/specialitate):_______________________
Situaia colar general: ___________________________________________________
Situaia absenelor: ________________________________________________________
Performane:_____________________________________________________________
Activiti extracolare: _____________________________________________________

Observaii: ______________________________________________________________
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Data:

Obiectul edinei/ Natura interveniei