FISA DE CONSILIERE A ELEVULUI

Data:_____________
Date biografice:
Cod:___________________________________________
Nume si prenume:________________________________
Domiciliu:_______________________________________
Data nasterii:____________________________________
Timpul alocat acestei discutii________________________
Date despre familie:
Tipul familiei:legitima____, nelegitima____;
Parintii:naturali__, adoptivi__, divortati__, decedati__,recasatoriti__, plasament__;
Frati:nr._____, B._______, F._______.
Ocupatia parintilor: Tata:_________________________
Mama:________________________
Date despre scolarizare:
Scoala:_________________________________________________
Clasa:______________; A repetat clasa:da_____, nu________;
Obiectul de studiu la care are rezultatele cele mai bune:
_______________________________________________________
Obiectul de studiu la care are rezultatele cele mai slabe:
_______________________________________________________
Trasaturi de personalitate:
Interese dominante pentru:_______________________________________________
Aptitudini pentru:_______________________________________________________
Capacitatea de relationare cu: clasa:_______________________________________
Cadre didactice:_______________________________
Mediul extrascolar:_____________________________
Echilibrul emotional:stabil__________, instabil___________.
Iritabilitate: mica_____, medie_____, mare_____;
Atitudinea fata de colegi:respingere___, indiferenta___, acceptare____, cooperare___;
Atitudine fata de invatare:dezinteres___, implicare:minima___, medie___, mare___;
Trasaturi voluntare ale caracterului: hotarare___, initiativa___, autocontrol___, spirit de
conducere___, creativitate___.

Problemele prezentate de catre elev:

Descrierea problemei:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Tema discutiei cu consilierul in cadrul sedintei de astazi:
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
Plan de interventie
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________

Stadiul cazului

Finalizat
Nefinalizat

Consilier scolar:
CABINET DE ASISTENTA PSIHOPEDAGOGICA