Model

Fişă de caracterizare psihologică a elevului (la solicitare)

Instituţia de învăţământ_____________________________________________
Nume, prenume __________________________________________________
Data naşterii/Vârsta _______________________________________________
Clasa __________________________________________________________
Data completării _________________________________________________
I. Date despre familie
_____________________________________________________________________________________
_____________________________________________________________________________________
II. Date medicale (dezvoltarea fizică şi starea generală a sănătăţii) ___________________________
_____________________________________________________________________________________

III. Procese intelectuale şi stilul de muncă

Nivelul de inteligenţă _______________________________________________________________
Limbajul _________________________________________________________________________
Memoria _________________________________________________________________________
Gândirea _________________________________________________________________________
Atenţia ___________________________________________________________________________
Spiritul de observaţie _______________________________________________________________
Imaginaţia ________________________________________________________________________
Motivaţia ________________________________________________________________________
Stilul de muncă ____________________________________________________________________
IV. Conduita la lecţii şi în colectivul clasei
Participarea la lecţii ________________________________________________________________
Disciplina la lecţii__________________________________________________________________
Participare la viaţa colectivului clasei __________________________________________________
Aprecieri ale colectivului de elevi _____________________________________________________
_________________________________________________________________________________

Statutul în grup ____________________________________________________________________

Aprecieri ale cadrelor didactice, dirigintelui _____________________________________________
_______________________________________________________________________________

V. Trăsături de personalitate
Tipul dominant de temperament _______________________________________________________
Emotivitatea ______________________________________________________________________
Trăsături dominante de caracter
 Pozitive _______________________________________________________________________
 Negative ______________________________________________________________________
VI. Interese, înclinaţii, aptitudini ________________________________________________________
__________________________________________________________________________________

VII. CONCLUZII __________________________________________________________________

____________________________________________________________________________________
_____________________________________________________________________________________
VIII. RECOMANDĂRI ______________________________________________________________
__________________________________________________________________________________

Psiholog __________________________________

Semnătura ________________________________
Sursa bibliografică: Organizarea activităţii serviciului de asistenţă psihologică.,Ghid metodologic,
Chişinău, 2011.