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PROGRAM DE INTERVENTIE PERSONALIZAT

I. INFORMAŢII DE BAZĂ

Numele si prenumele şcolarului: ______________________________________________


Data naşterii: ______________________
Domiciliul: ____________________________________________________________________
Clasa: _______________________________________________________________________
Echipa de intervenţie: __________________________________________________________
Data elaborării planului: ____________________
II. STAREA ACTUALĂ A ŞCOLARULUI
 DIAGNOSTIC:

 Medical:_________________________________________________________________
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 psihologic:_______________________________________________________________
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 psihopedagogic: __________________________________________________________
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 COMPORTAMENT COGNITIV
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 AUTONOMIA PERSONALĂ ŞI SOCIALĂ

 Aria de autoservire: ______________________________________________________


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 Aria de socializare: ___________________________________________________
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 Aria comportamentelor psihomotrice: ______________________________________
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 EVALUARE INIŢIALĂ
 Instrumente folosite în evaluare:
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 Observaţii:______________________________________________________________
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III. DERULAREA PROGRAMULUI DE INTERVENŢIE

 Domeniul/domeniile de intervenţie: _________________________________________


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 Scopul programului de intervenţie:_________________________________________
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 Obiective pe termen scurt: _________________________________________________
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 Obiective pe termen lung: _________________________________________________
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IV. EVALUAREA CRITERIALĂ

 Criterii de evaluare minimală:


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 Criterii de evaluare maximală:
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 Instrumente de evaluare:
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STRUCTURA PROGRAMULUI DE INTERVENŢIE PERSONALIZAT
Domeniul de intervenţie:__________________________________
Perioada vizată:_________________________________________

Nr. crt. Obiective Metode şi mijloace de realizare Perioada Criterii de Metode şi


de evaluare instrumente
timp de evaluare

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VI. CONCLUZII:
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V. RECOMANDARI
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