Imstituţia _________________________________________________________________________ Data, luna, anul naşterii _____________________________________________________________
I. Date personale a elevului/ elevei _____________________________________________________
• Date de stare civilă (tata,mama) ___________________________________________________________________________________ ___________________________________________________________________________________ • Şcoli frecventate şi localitatea în care au domiciliul stabil ___________________________________________________________________________________ ___________________________________________________________________________________ II. Date asupra stării de sănătate Antecedente ereditare şi condiţii de mediu ________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________
Starea generală a sănătăţii ______________________________________________________________
___________________________________________________________________________________ ___________________________________________________________________________________ Menţiuni medicale cu importanţă pentru procesul de învăţămînt ____________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ III. Date despre mediul familial •Familia_____________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ • Caracteristicile vieţii de familie ________________________________________________________ ___________________________________________________________________________________ • Gradul de integrare al elevului în familie _________________________________________________ ___________________________________________________________________________________ • Atenţia acordată formării copilului ______________________________________________________ • Influenţe extrafamiliale _______________________________________________________________ • Acţiuni ale şcolii în colaborare cu familia ________________________________________________ ___________________________________________________________________________________ IV. Date asupra şcolarităţii • Situaţia şcolară _____________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ • Gradul de integrare a copilului în şcoală _________________________________________________ ___________________________________________________________________________________ • Succese deosebite la concursuri,olimpiade, competiţii ______________________________________ • Activitatea în cercurile de elevi ________________________________________________________ • Preocupări în afara şcolii ______________________________________________________________ • Factori explicativi ai reuşitei sau nereuşitei şcolare _________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ • Recomandări pentru ameliorarea nivelului de pregătire şi educaţie _____________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ V. Date asupra structurii psihologice • Caracteristicile proceselor intelectuale 1. Memoria - viteza de memorare a cunoştinţelor (rapidă, medie,lentă) ____________________________________ ___________________________________________________________________________________ - durata păstrării cunoştinţelor (de lungă durată, medie, de scurtă durată) _________________________ ___________________________________________________________________________________ - reproducerea cunoştinţelor (fidelă, creatoare, cu dificultăţi) __________________________________ ___________________________________________________________________________________ 2. Imaginaţia - formele imaginaţiei (reproductivă sau creatoare) ___________________________________________ 3. Gândirea - capacitatea de a utiliza operaţiile gândirii (analiza,sinteza, comparaţia, abstractizarea, generalizarea, concretizarea) ________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ - operaţiile instrumentale (algoritmica şi euristica) __________________________________________ - predominanta gândirii (convergenţa sau divergenţa) ________________________________________ 4. Limbajul - volumul vocabularului (bogat,sărac,mediu) _______________________________________________ - forma de limbaj (concret,contextual,monologat,dialogat) ____________________________________ - limbajul general (coerent,incoerent,expresiv,inexpresiv etc) __________________________________ - Construcţia ideilor în cadrul comunicării cu adulţii şi între copii (exprimare bogată în idei, săracă) ___________________________________________________________________________________ 5. Atenţia - stabilitatea atenţiei în timpul învăţării (la şcoală, acasă) _____________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ - stabilitatea atenţiei în jocul individual şi în grup ___________________________________________ ___________________________________________________________________________________ - Concentrarea atenţiei în raport cu anumiţi factori perturbatori (f.bună, bună, slabă) ________________ VI. Caracteristici de personalitate 1. trăsături temperamentale - mobilitate (rapidă,medie, lentă) ________________________________________________________ - stabilitatea conduitei (stabil,instabil) ____________________________________________________ - intensitatea reacţiilor (reţinut, exploziv) __________________________________________________ - rezistenţă la efort (rezistent,oboseşte uşor) ________________________________________________ 2. Trăsături de caracter - Sociabilitatea _______________________________________________________________________ - Capacitatea de comunicare ____________________________________________________________ - Spirit de prietenie ___________________________________________________________________ - Sinceritate _________________________________________________________________________ - Respect faţă de adult _________________________________________________________________ - Politeţe ____________________________________________________________________________ - Simţ de ordine ______________________________________________________________________ - Hărnicie ___________________________________________________________________________ - Respect pentru muncă _______________________________________________________________ 3. Aptitudini (PUNCTE FORTE) - Interese ___________________________________________________________________________ - Înclinaţii __________________________________________________________________________ ___________________________________________________________________________________ - Preocupări _________________________________________________________________________ - Aptitudini _________________________________________________________________________ ___________________________________________________________________________________ - Talent ____________________________________________________________________________ PUNCTE SLABE: __________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ VI. Recomandări ____________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________
Data completării ___ __________________________ 20 ____