DEPARTAMENTO DE EDUCACIN ESPECIAL

EVALUACIN PSICOPEDAGGICA
EDUCACIN INICIAL
(LACTANTES, MATERNAL e INTERVENCIN TEMPRANA)
1. DATOS GENERALES
a) DATOS PERSONALES
Nombre del nio:__________________________________________________________ Sexo:______
C.U.R.P.: __________________________ Fecha de nacimiento:_________ Edad:___ aos ___
meses.
Domicilio:___________________________________________________Telfono:________________N.E.E
. asociadas a______________________________________________ Clave:_________________

Servicio
Intervencin Temprana
Otro CEN.D.I.
C.A.M. Esc. De Educ. Esp.
Otra institucin
Del hogar

EXPERIENCIA EDUCATIVA
Perodo (meses y aos)

Contina asistiendo

Escuela (actual):______________________________________________________________________
Perodo escolar:_____________________________________ Grado:___________ Grupo:__________
Nombre del(a) Educador(a):____________________________________________________________
Nombre del(a) Maestro(a) de Apoyo:_____________________________________________________
b) DATOS FAMILIARES

TIPO de FAMILIA
FUNCIONAL
(Relaciones
DISFUNCIONAL (Relaciones
familiares armoniosas)
familiares SIN armona)
NUCLEAR [Conformada solamente por padre, madre e hijo(s)]
EXTENSIVA (Cuando hay ms parientes agregados)
MIXTA (Cuando existe padrastro o madrastra)
DE UN SOLO PADRE (Cuando el padre o madre solo, es soltero, viudo o
divorciado)

Composicin de la familia:______________________________________________________________
Lugar que ocupa el nio entre sus hermanos:___________
PADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupacin:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
MADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupacin:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
Actitud de la familia ante el N.N.E.E.:_____________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________
Otros familiares con N.E.E.:_____________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________

2. MOTIVO de la EVALUACIN
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________

3. APARIENCIA FSICA

__________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________________

4. ANTECEDENTES del DESARROLLO

___________________________________________________________________________________________
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___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________

5. INSTRUMENTOS y/o TCNICAS APLICADAS

Instr. /Tcnica

Fech
a

Justificacin

Conducta

Aplicador

a) INTERPRETACIN de RESULTADOS

Consigo mismo

FORMAS de INTERACCIN
Con el mundo social

CAPACIDADES
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

Con el mundo fsico

DIFICULTADES
____________________________________________
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____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
__________________

INTERACCIONES que se ESTABLECEN en:

SALA
CENTRO ESCOLAR

FAMILIA

SOCIEDAD

DIAGNSTICO, SUGERENCIAS y/o ADECUACIONES para el APOYO que REQUIERE:

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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___________________________________________________________________________________________
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___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________________________________
b) EVOLUCIN en las ESFERAS del DESARROLLO
Evolucin y
Desarrollo
Motriz
Comunicati
vo
Socioafectiv
o
Cognitivo

Fech
a

Por arriba
A s
mism
o

Del
grupo

Igual
A s
mism
o

Del
grupo

Por debajo
A s
mism
o

Del
grupo

Observaciones

c) EVOLUCIN y DESARROLLO en su COMPETENCIA CURRICULAR

rea del
Desarroll
o

Fech
a

El alumno es capaz de hacer

NIVEL de COMPETENCIA CURRICULAR

Con ayuda, el alumno es capaz Tipos de ayuda que requiere
de hacer

El alumno todava NO es
capaz de hacer

Nombre y
firma

d) ALCANCES OBTENIDOS al FINAL del CICLO ESCOLAR

Fecha:__________________

LACTANTES
:

II

III

MATERNAL
:

II

III

REAS
del
DESARROLLO
Personal:________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________
_______________________________________________________________________

Social:___________________________________________________________________________________
______________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________

Ambiental:______________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________
___________________________________________________________________________________________
___________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________

6. CONCLUSIONES y RECOMENDACIONES:
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________

PERSONAL que INTERVINO en la ATENCIN del N.N.E.E.

Educador(a)

Maestro(a) de Apoyo

Psiclogo(a)

Maestro(a) en Comunicacin

Trabajador(a) Social

Director(a) de U.S.A.E.R.

Director(a) de Escuela

San Luis Potos, S.L.P., a ______de _________________________________del_______________

DEPARTAMENTO DE EDUCACIN ESPECIAL

EVALUACIN PSICOPEDAGGICA
PREESCOLAR
1. DATOS GENERALES
a) DATOS PERSONALES
Nombre del nio:__________________________________________________________ Sexo:______

C.U.R.P.: __________________________ Fecha de nacimiento:_________ Edad:___ aos ___

meses.
Domicilio:___________________________________________________Telfono:________________N.E.E
. asociadas a______________________________________________ Clave:_________________

Servicio
Otro(s)
Preescolar(es)
Regular(es)
C.A.P.E.P.
Intervencin Temprana
C.A.M. Esc. de Educ. Esp.
Otra institucin
Del hogar

EXPERIENCIA EDUCATIVA
Perodo (meses y aos)

Contina asistiendo

Escuela (actual):______________________________________________________________________
Perodo escolar:_____________________________________ Grado:___________ Grupo:__________
Nombre del(a) Educador(a):____________________________________________________________
Nombre del(a) Maestro(a) de Apoyo:_____________________________________________________
b) DATOS FAMILIARES

TIPO de FAMILIA
FUNCIONAL
(Relaciones
DISFUNCIONAL (Relaciones
familiares armoniosas)
familiares SIN armona)
NUCLEAR [Conformada solamente por padre, madre e hijo(s)]
EXTENSIVA (Cuando hay ms parientes agregados)
MIXTA (Cuando existe padrastro o madrastra)
DE UN SOLO PADRE (Cuando el padre o madre solo, es soltero, viudo o
divorciado)

Composicin de la familia:______________________________________________________________
Lugar que ocupa el nio entre sus hermanos:___________
PADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupacin:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
MADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupacin:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
Actitud de la familia ante el N.N.E.E.:_____________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________
Otros familiares con N.E.E.:_____________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________

2. MOTIVO de la EVALUACIN
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________

3. APARIENCIA FSICA
__________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________

___________________________________________________________________________________

4. ANTECEDENTES del DESARROLLO

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________

5. INSTRUMENTOS y/o TCNICAS APLICADAS

Instr. /Tcnica

Fech
a

Justificacin

Conducta

Aplicador

a) INTERPRETACIN de RESULTADOS
ESTILOS de APRENDIZAJE y MOTIVACIN para APRENDER
Cmo aprende el alumno?
Qu es lo que le motiva a aprender?

CAPACIDADES
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

DIFICULTADES
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
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____________________________________________
____________________________________________
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____________________________________________
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____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
___________________________

INTERACCIONES que se ESTABLECEN en:

AULA
CENTRO ESCOLAR

FAMILIA

SOCIEDAD

DIAGNSTICO, SUGERENCIAS y/o ADECUACIONES para el APOYO que REQUIERE:

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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___________________________________________________________________________________________
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___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________________________________
b) EVOLUCIN en las ESFERAS del DESARROLLO
Evolucin y
Desarrollo
Motriz
Comunicati
vo
Socioafectiv
o
Cognitivo

Fech
a

Por arriba
A s
mism
o

Del
grupo

Igual
A s
mism
o

Del
grupo

Por debajo
A s
mism
o

Del
grupo

Observaciones

c) EVOLUCIN y DESARROLLO en su COMPETENCIA CURRICULAR

Dimensi
n

Fech
a

El alumno es capaz de hacer

NIVEL de COMPETENCIA CURRICULAR

Con ayuda, el alumno es capaz Tipos de ayuda que requiere
de hacer

El alumno todava NO es
capaz de hacer

Nombre y
firma

d) ALCANCES OBTENIDOS al FINAL del CICLO ESCOLAR

GRADO:

Fecha:__________________
3

D I M E N S I O N E S
Afectiva:________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________
_______________________________________________________________________

Social:___________________________________________________________________________________
______________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__

Intelectual:______________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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__________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________
___________________________________________________________________________________________
___________________________________________________
___________________________________________________________________________________________
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___________

Fsica:___________________________________________________________________________________
___________________________________________________________________________________________
__________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________

6. CONCLUSIONES y RECOMENDACIONES
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

___________________________________________________________________________________________
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___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________

PERSONAL que INTERVINO en la ATENCIN del N.N.E.E.

Educador(a)

Maestro(a) de Apoyo

Psiclogo(a)

Maestro(a) en Comunicacin

Trabajador(a) Social

Director(a) de U.S.A.E.R.

Director(a) de Escuela

San Luis Potos, S.L.P., a ______de _________________________________del_______________

DEPARTAMENTO DE EDUCACIN
ESPECIAL
U S A E R No. 26
EVALUACIN PSICOPEDAGGICA
PRIMARIA
1. DATOS GENERALES
a) DATOS PERSONALES

Nombre del nio:__________________________________________________________ Sexo:______

C.U.R.P.: __________________________ Fecha de nacimiento:_________ Edad:___ aos ___
meses.
Domicilio:___________________________________________________Telfono:________________N.E.E
. asociadas a______________________________________________ Clave:_________________

Servicio
Intervencin Temprana
C.A.P.E.P.
Grupo de Apoyo
Preescolar Regular
Otra(s)
Primaria(s)
Regular(es)
Centro Psicopedaggico
Esc. de Educ Especial o
C.A.M.
Otro (especificar)

Si

N
o

Cul
?

EXPERIENCIA EDUCATIVA
Perodo (meses y aos)

Contina asistiendo

Ha REPROBADO algn GRADO?

No. de
Motivo
veces

Escuela (actual):______________________________________________________________________
Ciclo escolar: _______________________________________Grado:___________ Grupo:__________
Nombre del(a) Maestro(a) de Grupo:_____________________________________________________
Nombre del(a) Maestro(a) de Apoyo:_____________________________________________________
b) DATOS FAMILIARES

TIPO de FAMILIA
FUNCIONAL
(Relaciones
DISFUNCIONAL (Relaciones
familiares armoniosas))
familiares SIN armona)
NUCLEAR [Conformada solamente por padre, madre e hijo(s)]
EXTENSIVA (Cuando hay ms parientes agregados)
MIXTA (Cuando existe padrastro o madrastra)
DE UN SOLO PADRE (Cuando el padre o madre solo, es soltero, viudo o
divorciado)
Composicin de la familia:______________________________________________________________
Lugar que ocupa el nio entre sus hermanos:___________
PADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupacin:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
MADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupacin:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
Actitud de la familia ante el N.N.E.E.:_____________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________
Otros familiares con N.E.E.:_____________________________________________________________

2. MOTIVO de la EVALUACIN
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________

3. APARIENCIA FSICA
_________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________

_________________________________________________________________________________

4. ANTECEDENTES del DESARROLLO

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
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_________________________________________________________________
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_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
______________
5. INSTRUMENTOS y/o TCNICAS APLICADAS
Instr. /Tcnica

Fech
a

Justificacin

Conducta

Aplicador

a) INTERPRETACIN de RESULTADOS
ESTILOS de APRENDIZAJE y MOTIVACIN para APRENDER
Cmo aprende el alumno?
Qu es lo que le motiva a aprender?

CAPACIDADES

_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________

DIFICULTADES

_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________

_______________________________
_______________________________
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_______________________________
_______________________________
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_______________________________
_______________________________
_______________________________
_____

_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_______________________________
_____

INTERACCIONES que se ESTABLECEN en:

AULA
CENTRO ESCOLAR

FAMILIA

SOCIEDAD

DIAGNSTICO, SUGERENCIAS y/o ADECUACIONES para el APOYO que REQUIERE:

Diagnstico:___________________________________________________
_________________________________________________________________
_________________________________________________________________
_____________________________________________Sugerencias:_____
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________
Adecuaciones:________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
________________________________________
b) EVOLUCIN en las ESFERAS del DESARROLLO
Evolucin y
Desarrollo
Motriz
Comunicativ
o
Socioafectiv
o
Cognitivo

Fech
a

Por arriba
A s
mism
o

Del
grupo

Igual
A s
mism
o

Del
grupo

Por debajo
A s
mism
o

Del
grupo

Observaciones

c) EVOLUCIN y DESARROLLO en su COMPETENCIA CURRICULAR

rea o
Asignatur
a

Fech
a

El alumno es capaz de hacer

NIVEL de COMPETENCIA CURRICULAR

Con ayuda, el alumno es capaz Tipos de ayuda que requiere
de hacer

El alumno todava NO es
capaz de hacer

Nombre y
firma

d) ALCANCES OBTENIDOS al FINAL del CICLO ESCOLAR

Fecha:__________________

GRADO:
1

ESFERAS

del

DESARROLLO

Motriz:_________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
____________________

Comunicacin:________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________

Socioafectiva:_________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________

Cognitiva:_____________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
______________________
_________________________________________________________________
____________________________________________________________

6. CONCLUSIONES y RECOMENDACIONES

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_____________________________________________________
PERSONAL que INTERVINO en la ATENCIN del N.N.E.E.

Maestro (a) de grupo

Maestro(a) de Apoyo

Psiclogo(a)

Maestro(a) en Comunicacin

Trabajador(a) Social

Director(a) de U.S.A.E.R. No. 26

Director(a) de Escuela

Matehuala, S.L.P., A ______ de JULIO de 2014.

DEPARTAMENTO DE EDUCACIN ESPECIAL

EVALUACIN PSICOPEDAGGICA
SECUNDARIA
1. DATOS GENERALES

a) DATOS PERSONALES
Nombre del alumno:_______________________________________________________ Sexo:______
C.U.R.P.: __________________________ Fecha de nacimiento:_________ Edad:___ aos ___
meses.
Domicilio:___________________________________________________Telfono:________________N.E.E
. asociadas a______________________________________________ Clave:_________________

Servicio
Intervencin Temprana
C.A.P.E.P.
Grupo de Apoyo
Preescolar Regular
Primaria Regular
Otra(s)
Secundaria(s)
Regular(es)
Centro Psicopedaggico
Esc. de Educ Especial o
C.A.M.
Otro (especificar)

Si

No

EXPERIENCIA EDUCATIVA
Perodo (meses y aos)

Contina asistiendo

Ha REPROBADO alguna(s) MATERIA(S) TODO un GRADO?

Grad No. de
Materia
Motivo
o

veces

Escuela (actual):______________________________________________________________________
Ciclo escolar: _______________________________________Grado:___________ Grupo:__________
Nombre de la Persona que lo canaliza:____________________________________________________
Funcin que desempea: _____________________________________________
Nombre del(a) Maestro(a) de Apoyo:_____________________________________________________
b) DATOS FAMILIARES
TIPO de FAMILIA
FUNCIONAL
(Relaciones
DISFUNCIONAL (Relaciones
familiares armoniosas)
familiares SIN armona)
NUCLEAR [Conformada solamente por padre, madre e hijo(s)]
EXTENSIVA (Cuando hay ms parientes agregados)
MIXTA (Cuando existe padrastro o madrastra)
DE UN SOLO PADRE (Cuando el padre o madre solo, es soltero, viudo o
divorciado)
Composicin de la familia:______________________________________________________________
Lugar que ocupa el(la) joven entre sus hermanos:___________
PADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupacin:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
MADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupacin:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
Actitud de la familia ante el A.N.E.E.:_____________________________________________________
___________________________________________________________________________________
Otros familiares con N.E.E.:_____________________________________________________________

2. MOTIVO de la EVALUACIN
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________

3. APARIENCIA FSICA
__________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________________

4. ANTECEDENTES del DESARROLLO

___________________________________________________________________________________________
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___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________

5. INSTRUMENTOS y/o TCNICAS APLICADAS

Instr. /Tcnica

Fech
a

Justificacin

Conducta

Aplicador

a) INTERPRETACIN de RESULTADOS
ESTILOS de APRENDIZAJE y MOTIVACIN para APRENDER
Cmo aprende el alumno?
Qu es lo que le motiva a aprender?

CAPACIDADES
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

DIFICULTADES
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
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____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
___________________________

INTERACCIONES que se ESTABLECEN en:

AULA
CENTRO ESCOLAR

FAMILIA

SOCIEDAD

DIAGNSTICO, SUGERENCIAS y/o ADECUACIONES para el APOYO que REQUIERE:

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_____________________________________________________________________________________

b) EVOLUCIN y DESARROLLO en su COMPETENCIA CURRICULAR

rea, Asiog.
Activ.
Comp.

Fech
a

El alumno es capaz de
hacer

NIVEL de COMPETENCIA CURRICULAR

Con ayuda, el alumno es capaz Tipos de ayuda que requiere
de hacer

El alumno todava NO es
capaz de hacer

Nombre y
firma

c) EVOLUCIN en las ESFERAS del DESARROLLO por REA, ASIGNATURA

ACTIVIDADES COMPLEMENTARIAS

Evolucin y
Desarrollo

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Observaciones

Del
grupo

MOTRIZ
rea, Asig.
Activ. Compl.:
____________
MOTRIZ
rea, Asig.
Activ. Compl.
____________
MOTRIZ
rea, Asig.
Activ. Compl.:
____________
Evolucin y
Desarrollo

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Observaciones

Del
grupo

COMUNICATIV
O

rea, Asig.
Activ. Compl.
____________
COMUNICATIV
O rea, Asig.

Activ.
Compl.
____________
COMUNICATIV
O rea, Asig.

Activ.
Compl.
____________

Evolucin y
Desarrollo

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Observaciones

Del
grupo

SOCIOAFECTIV
O

rea, Asig.
Activ. Compl.
____________
SOCIOAFECTIV
O rea, Asig.

Activ.
Compl.
____________
SOCIOAFECTIV
O rea, Asig.

Activ.
Compl.
____________

Evolucin y
Desarrollo
COGNITIVO
rea, Asig.
Activ. Compl.
____________
COGNITIVO
rea, Asig.
Activ. Compl.
____________

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Del
grupo

Observaciones

COGNITIVO
rea, Asig.
Activ. Compl.
____________

d) ALCANCES OBTENIDOS al FINAL del CICLO ESCOLAR

GRADO:

Fecha:__________________
3

ESFERAS del DESARROLLO

Motriz:___________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________

Comunicacin:__________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________

Socioafectiva:___________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________

Cognitiva:_______________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_________________________________

6. CONCLUSIONES y RECOMENDACIONES
___________________________________________________________________________________________
___________________________________________________________________________________________

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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___________________________________________________________________________________________
_________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________

PERSONAL que INTERVINO en la ATENCIN del A.N.E.E.

Educador(a)

Maestro(a) de Apoyo

Psiclogo(a)

Maestro(a) en Comunicacin

Trabajador(a) Social

Director(a) de U.S.A.E.R.

Director(a) de Escuela

San Luis Potos, S.L.P., a ______de _________________________________del_______________

DEPARTAMENTO DE EDUCACIN ESPECIAL

EVALUACIN PSICOPEDAGGICA
CAPACITACIN LABORAL
1. DATOS GENERALES

a) DATOS PERSONALES
Nombre del alumno:_______________________________________________________ Sexo:______
C.U.R.P.: __________________________ Fecha de nacimiento:_________ Edad:___ aos ___
meses.
Domicilio:___________________________________________________Telfono:________________N.E.E
. asociadas a______________________________________________ Clave:_________________

Servicio
Intervencin Temprana
C.A.P.E.P.
Grupo de Apoyo
Preescolar Regular
Primaria Regular
Otra(s)
Secundaria(s)
Regular(es)
Centro Psicopedaggico
Esc. de Educ Especial o
C.A.M.
Otro (especificar)

Si

No

EXPERIENCIA EDUCATIVA
Perodo (meses y aos)

Contina asistiendo

Ha REPROBADO alguna(s) MATERIA(S) TODO un GRADO?

Grad No. de
Materia
Motivo
o

veces

Escuela (actual):_____________________________________________ Fecha de Ingreso: _________

Ciclo escolar: ____________ Taller: __________________Mdulo: ____ Puesto:__________________
Nombre del(a) Instructor(a) de Taller: ____________________________________________________
b) DATOS FAMILIARES
TIPO de FAMILIA
FUNCIONAL
(Relaciones
DISFUNCIONAL (Relaciones
familiares armoniosas)
familiares SIN armona)
NUCLEAR [Conformada solamente por padre, madre e hijo(s)]
EXTENSIVA (Cuando hay ms parientes agregados)
MIXTA (Cuando existe padrastro o madrastra)
DE UN SOLO PADRE (Cuando el padre o madre solo, es soltero, viudo o
divorciado)
Composicin de la familia:______________________________________________________________
Lugar que ocupa el(la) joven entre sus hermanos:___________
PADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupacin:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
MADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupacin:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
Actitud de la familia ante el A.N.E.E.:_____________________________________________________
___________________________________________________________________________________
Otros familiares con N.E.E.:_____________________________________________________________

2. MOTIVO de la EVALUACIN
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________

3. APARIENCIA FSICA
__________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________________

4. ANTECEDENTES del DESARROLLO

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________

5. INSTRUMENTOS y/o TCNICAS APLICADAS

Instr. /Tcnica

Fech
a

Justificacin

Conducta

Aplicador

a) INTERPRETACIN de RESULTADOS
ESTILOS de APRENDIZAJE y MOTIVACIN para APRENDER
Cmo aprende el alumno?
Qu es lo que le motiva a aprender?

CAPACIDADES
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

DIFICULTADES
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________

____________________________________________
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____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
___________________________

INTERACCIONES que se ESTABLECEN en:

TALLER
CENTRO ESCOLAR

FAMILIA

SOCIEDAD

DIAGNSTICO, SUGERENCIAS y/o ADECUACIONES para el APOYO que REQUIERE:

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_____________________________________________________________________________________

b) EVOLUCIN y DESARROLLO en su COMPETENCIA CURRICULAR

Mdulo y
Puesto de
Trabajo

Fech
a

NIVEL de COMPETENCIA CURRICULAR, en el TALLER: _________________________________

El alumno es capaz de
Con ayuda, el alumno es capaz Tipos de ayuda que requiere
El alumno todava NO es
hacer
de hacer
capaz de hacer

Nombre y
firma

c) EVOLUCIN en las ESFERAS del DESARROLLO en EDUCACIN

EDUCACIN ARTSTICA ACTIVIDADES COMPLEMENTARIAS

FSICA,

TALLER: ____________________ MDULO: ________ PUESTO DE TRABAJO: _________

Evolucin y
Desarrollo

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Observaciones

Del
grupo

MOTRIZ
E.A., E.F.
Activ. Compl.:
____________
MOTRIZ
E.A., E.F.
Activ. Compl.:
____________
MOTRIZ
E.A., E.F.
Activ. Compl.:
____________
Evolucin y
Desarrollo

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Observaciones

Del
grupo

COMUNICATIV
O

E.A., E.F.
Activ. Compl.:
____________
COMUNICATIV
O

E.A., E.F.
Activ. Compl.:
____________
COMUNICATIV
O

E.A., E.F.
Activ. Compl.:
____________
Evolucin y
Desarrollo

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Observaciones

Del
grupo

SOCIOAFECTIV
O

E.A., E.F.
Activ. Compl.
____________
SOCIOAFECTIV
O E.A., E.F.

Activ. Compl.
____________

SOCIOAFECTIV
O E.A., E.F.

Activ. Compl.
____________
Evolucin y
Desarrollo
COGNITIVO
E.A., E.F.
Activ. Compl.
____________
COGNITIVO
E.A., E.F.
Activ. Compl.
____________

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Del
grupo

Observaciones

COGNITIVO
E.A., E.F.
Activ. Compl.
____________
d) ALCANCES OBTENIDOS al FINAL del CICLO ESCOLAR
TALLER:

MDULO
:

Fecha:__________________

PUESTO DE
TRABAJO:

ESFERAS del DESARROLLO

Motriz:___________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________

Comunicacin:__________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________

Socioafectiva:___________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________

Cognitiva:_______________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_________________________________

6. CONCLUSIONES y RECOMENDACIONES
___________________________________________________________________________________________
___________________________________________________________________________________________

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
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___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________

PERSONAL que INTERVINO en la ATENCIN del A.N.E.E.

Trabajador(a) Social

Director(a) de C.A.M.

Psiclogo(a)

Maestro(a) en Comunicacin

Instructor(a) de Taller

Maestro(a) Especialista (Pedagogo)

San Luis Potos, S.L.P., a ______de _________________________________del_______________