CABINETUL DE ASISTENŢĂ PSIHOPEDAGOGICĂ

Unitatea școlară_______________________________________
An școlar ___________________

FORMULAR APP

1. Date factuale:
Numele şi prenumele:___________________________________________________________________
Data naşterii:__________________________________________________________________________
Clasa:_______________________________________________________________________________
Numele şi prenumele/ studii:
-tata_______________________________________________________________________________
-mama_____________________________________________________________________________
Ocupaţia actuală a părinţilor:
-tata_______________________________________________________________________________
-mama_____________________________________________________________________________
2. Factori legaţi de familie:
Structura familiei:_____________________________________________________________________
Situaţia materială a familiei:_____________________________________________________________
Relaţii interpersonale cu membrii familiei :_________________________________________________
____________________________________________________________________________________
__________________________________________________________________________________
Situaţii deosebite în familie:_____________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3. Factori legaţi de şcoală:
Prezenţa la cursuri (ore)________________________________________________________________
___________________________________________________________________________________
Performanţe şcolare:__________________________________________________________________
Comportamentul manifestat în mediul şcolar:_______________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Relaţii interpersonale:
-cu colegii_____________________________________________________________________
___________________________________________________________________________________
-cu dirigintele__________________________________________________________________
____________________________________________________________________________________
-cu profesorii_ _________________________________________________________________
 4. Influenţa mass-mediei şi a grupurilor stradale:
Frecvenţa grupurilor stradale:__________________________________________________________
____________________________________________________________________________________
Componenţa grupurilor stradale:
_________________________________________________________
___________________________________________________________________________________

5. Definirea problemei:

6. Demersul intervenţiei educaţionale:

Obiective Nr. Metode/ instrumente utilizate
ședinţei
Exemple obiective:
-construirea relaţiei 1.

-identificarea problemei
-pozitivarea imaginii de
2.
sine
-testare psihologica
-stabilirea profilului
psihologic

7. Evaluarea eficienţei intervenţiei