Repblica Bolivariana de Venezuela

Ministerio del Poder Popular para la Educacin

Coordinacin de Educacin Especial
U. E. N. B. Riberas del Torbes
Aula Integrada El Ribereito
Municipio Crdenas - Estado Tchira

Lugar ____________________________ Fecha _____________________________

I.- DATOS DE IDENTIFICACION DEL ESCOLAR

Nombres y Apellidos del estudiante: ___________________________________________

Lugar y Fecha de Nacimiento: _____________________ Edad C.___________________
Escolarizado: Si __________ No __________
Grado__________ Turno _____________ Repitencia _______________________
Representante: ___________________________________________________________________________
Direccin: _______________________________________________________________________________
Telfono: _______________________________________________________________
Referido por: _____________________________________________________________________________
Docente de Aula Regular: ___________________________________________________________________
Motivo:__________________________________________________________________________________
________________________________________________________________________________________

II.- RESULTADOS DE LA EVALUACION

rea Acadmica: Lectura, Escritura y Clculo.
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
rea Psicofuncional
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
rea Socioemocional
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Sntesis Diagnstica
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
Recomendaciones
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

______________________________
Docente de Aula Integrada