Eval Psicop. Forma

DEPARTAMENTO DE EDUCACIÓN ESPECIAL
EVALUACIÓN PSICOPEDAGÓGICA (FOTO)

EDUCACIÓN INICIAL
(LACTANTES, MATERNAL e INTERVENCIÓN TEMPRANA)
1. DATOS GENERALES
a) DATOS PERSONALES
Nombre del niño:__________________________________________________________ Sexo:______

C.U.R.P.: __________________________ Fecha de nacimiento:_________ Edad:___ años ___ meses.
Domicilio:___________________________________________________Teléfono:________________
N.E.E. asociadas a______________________________________________ Clave:_________________
EXPERIENCIA EDUCATIVA
Servicio Período (meses y años) Continúa asistiendo
Intervención Temprana
Otro CEN.D.I.
C.A.M. ó Esc. De Educ. Esp.
Otra institución
Del hogar
Escuela (actual):______________________________________________________________________
Período 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 armonía)
NUCLEAR [Conformada solamente por padre, madre e hijo(s)]
EXTENSIVA (Cuando hay más parientes agregados)
MIXTA (Cuando existe padrastro o madrastra)
DE UN SOLO PADRE (Cuando el padre o madre solo, es soltero, viudo o divorciado)
Composición de la familia:______________________________________________________________
Lugar que ocupa el niño entre sus hermanos:___________
PADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupación:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
MADRE
Actitud de la familia ante el N.N.E.E.:_____________________________________________________

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Otros familiares con N.E.E.:_____________________________________________________________

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2. MOTIVO de la EVALUACIÓN
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3. APARIENCIA FÍSICA
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4. ANTECEDENTES del DESARROLLO

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5. INSTRUMENTOS y/o TÉCNICAS APLICADAS
Instr. /Técnica Fecha Justificación Conducta Aplicador
a) INTERPRETACIÓN de RESULTADOS
FORMAS de INTERACCIÓN
Consigo mismo Con el mundo social Con el mundo físico
CAPACIDADES DIFICULTADES
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INTERACCIONES que se ESTABLECEN en:

SALA CENTRO ESCOLAR
FAMILIA SOCIEDAD
DIAGNÓSTICO, SUGERENCIAS y/o ADECUACIONES para el APOYO que REQUIERE:
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b) EVOLUCIÓN en las ESFERAS del DESARROLLO
Evolución y Fecha Por arriba Igual Por debajo Observaciones

Desarrollo A sí Del A sí Del A sí Del
mismo grupo mismo grupo mismo grupo
Motriz
Comunicativo
Socioafectivo
Cognitivo
c) EVOLUCIÓN y DESARROLLO en su COMPETENCIA CURRICULAR
NIVEL de COMPETENCIA CURRICULAR

Área del Fecha El alumno es capaz de hacer Con ayuda, el alumno es capaz de Tipos de ayuda que requiere El alumno todavía NO es capaz Nombre y
Desarrollo hacer de hacer firma
d) ALCANCES OBTENIDOS al FINAL del CICLO ESCOLAR Fecha:__________________
LACTANTES: I II III MATERNAL: I II III
ÁREAS del DESARROLLO

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6. CONCLUSIONES y RECOMENDACIONES:
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PERSONAL que INTERVINO en la ATENCIÓN del N.N.E.E.
Educador(a) Maestro(a) de Apoyo
Psicólogo(a) Maestro(a) en Comunicación
Trabajador(a) Social Director(a) de U.S.A.E.R.
Director(a) de Escuela
San Luis Potosí, S.L.P., a ______de _________________________________del_______________

EVALUACIÓN PSICOPEDAGÓGICA
PREESCOLAR
1. DATOS GENERALES
a) DATOS PERSONALES

Otro(s) Preescolar(es) Regular(es)
C.A.P.E.P.
C.A.M. ó Esc. de Educ. Esp.
Otra institución
Del hogar
Escuela (actual):______________________________________________________________________
Período escolar:_____________________________________ Grado:___________ Grupo:__________
Nombre del(a) Educador(a):____________________________________________________________
b) DATOS FAMILIARES
TIPO de FAMILIA
PADRE
MADRE

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ESTILOS de APRENDIZAJE y MOTIVACIÓN para APRENDER

¿Cómo aprende el alumno? ¿Qué es lo que le motiva a aprender?
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AULA CENTRO ESCOLAR
FAMILIA SOCIEDAD
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Motriz
Comunicativo
Socioafectivo
Cognitivo

Dimensión Fecha El alumno es capaz de hacer Con ayuda, el alumno es capaz de Tipos de ayuda que requiere El alumno todavía NO es capaz Nombre y
hacer de hacer firma
GRADO: 1° 2° 3°
D I M E N S I O N E S
Afectiva:_________________________________________________________________
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6. CONCLUSIONES y RECOMENDACIONES
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PRIMARIA
1. DATOS GENERALES
a) DATOS PERSONALES

C.A.P.E.P.
Grupo de Apoyo
Preescolar Regular
Otra(s) Primaria(s) Regular(es)
Centro Psicopedagógico
Esc. de Educ Especial o C.A.M.
Otro (especificar)
¿Ha REPROBADO algún GRADO?

Si No ¿Cuál? No. de veces Motivo
Escuela (actual):______________________________________________________________________
Ciclo escolar: _______________________________________Grado:___________ Grupo:__________
Nombre del(a) Maestro(a) de Grupo:_____________________________________________________
b) DATOS FAMILIARES
TIPO de FAMILIA
familiares armoniosas)) familiares SIN armonía)
PADRE
MADRE

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AULA CENTRO ESCOLAR
FAMILIA SOCIEDAD

Motriz
Comunicativo
Socioafectivo
Cognitivo

Área o Fecha El alumno es capaz de hacer Con ayuda, el alumno es capaz de Tipos de ayuda que requiere El alumno todavía NO es capaz Nombre y
Asignatura hacer de hacer firma
GRADO:
1° 2° 3° 4° 5° 6°
ESFERAS del DESARROLLO

Motriz
Comunicación
Socioafectiva
Cognitiva

SECUNDARIA
1. DATOS GENERALES
a) DATOS PERSONALES
Nombre del alumno:_______________________________________________________ Sexo:______

C.A.P.E.P.
Grupo de Apoyo
Preescolar Regular
Primaria Regular
Otra(s) Secundaria(s) Regular(es)
Otro (especificar)
¿Ha REPROBADO alguna(s) MATERIA(S) ó TODO un GRADO?

Si No Materia Grado No. de Motivo
veces
Escuela (actual):______________________________________________________________________
Ciclo escolar: _______________________________________Grado:___________ Grupo:__________
Nombre de la Persona que lo canaliza:____________________________________________________
Función que desempeña: _____________________________________________
b) DATOS FAMILIARES
TIPO de FAMILIA
Lugar que ocupa el(la) joven entre sus hermanos:___________
PADRE
MADRE
Actitud de la familia ante el A.N.E.E.:_____________________________________________________

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AULA CENTRO ESCOLAR
FAMILIA SOCIEDAD
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b) EVOLUCIÓN y DESARROLLO en su COMPETENCIA CURRICULAR

Área, Asiog. ó Fecha El alumno es capaz de hacer Con ayuda, el alumno es capaz de Tipos de ayuda que requiere El alumno todavía NO es capaz Nombre y
Activ. Comp.
c) EVOLUCIÓN en las ESFERAS del DESARROLLO por ÁREA, ASIGNATURA ó ACTIVIDADES
COMPLEMENTARIAS

Desarrollo De sí Del A sí Al De sí Del
MOTRIZ
Área, Asig. ó
Activ. Compl.:
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MOTRIZ
Área, Asig. ó
Activ. Compl.
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MOTRIZ
Área, Asig. ó
Activ. Compl.:
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COMUNICATIVO
Área, Asig. ó
Activ. Compl.
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COMUNICATIVO
Área, Asig. ó
Activ. Compl.
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COMUNICATIVO
Área, Asig. ó
Activ. Compl.
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SOCIOAFECTIVO
Área, Asig. ó
Activ. Compl.
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SOCIOAFECTIVO
Área, Asig. ó
Activ. Compl.
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SOCIOAFECTIVO
Área, Asig. ó
Activ. Compl.
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COGNITIVO
Área, Asig. ó
Activ. Compl.
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COGNITIVO
Área, Asig. ó
Activ. Compl.
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COGNITIVO
Área, Asig. ó
Activ. Compl.
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GRADO: 1° 2° 3°

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PERSONAL que INTERVINO en la ATENCIÓN del A.N.E.E.
CAPACITACIÓN LABORAL
1. DATOS GENERALES
a) DATOS PERSONALES
Nombre del alumno:_______________________________________________________ Sexo:______

C.A.P.E.P.
Grupo de Apoyo
Preescolar Regular
Primaria Regular
Otra(s) Secundaria(s) Regular(es)
Otro (especificar)
¿Ha REPROBADO alguna(s) MATERIA(S) ó TODO un GRADO?

Si No Materia Grado No. de Motivo
veces
Escuela (actual):_____________________________________________ Fecha de Ingreso: _________

Ciclo escolar: ____________ Taller: __________________Módulo: ____ Puesto:__________________
Nombre del(a) Instructor(a) de Taller: ____________________________________________________
b) DATOS FAMILIARES
TIPO de FAMILIA
Lugar que ocupa el(la) joven entre sus hermanos:___________
PADRE
MADRE
Actitud de la familia ante el A.N.E.E.:_____________________________________________________
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TALLER CENTRO ESCOLAR
FAMILIA SOCIEDAD
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b) EVOLUCIÓN y DESARROLLO en su COMPETENCIA CURRICULAR
NIVEL de COMPETENCIA CURRICULAR, en el TALLER: _________________________________

Módulo y Fecha El alumno es capaz de hacer Con ayuda, el alumno es capaz de Tipos de ayuda que requiere El alumno todavía NO es capaz Nombre y
Puesto de
Trabajo
c) EVOLUCIÓN en las ESFERAS del DESARROLLO en EDUCACIÓN FÍSICA, EDUCACIÓN
ARTÍSTICA ó ACTIVIDADES COMPLEMENTARIAS
TALLER: ____________________ MÓDULO: ________ PUESTO DE TRABAJO: _________

MOTRIZ
E.A., E.F. ó
Activ. Compl.:
____________
MOTRIZ
E.A., E.F. ó
Activ. Compl.:
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MOTRIZ
E.A., E.F. ó
Activ. Compl.:
____________

COMUNICATIVO
E.A., E.F. ó
Activ. Compl.:
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COMUNICATIVO
E.A., E.F. ó
Activ. Compl.:
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COMUNICATIVO
E.A., E.F. ó
Activ. Compl.:
____________

SOCIOAFECTIVO
E.A., E.F. ó
Activ. Compl.
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SOCIOAFECTIVO
E.A., E.F. ó
Activ. Compl.
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SOCIOAFECTIVO
E.A., E.F. ó
Activ. Compl.
____________

COGNITIVO
E.A., E.F. ó
Activ. Compl.
____________
COGNITIVO
E.A., E.F. ó
Activ. Compl.
____________
COGNITIVO
E.A., E.F. ó
Activ. Compl.
____________
TALLER: MÓDULO: PUESTO DE TRABAJO:

Motriz:__________________________________________________________________
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Comunicación:____________________________________________________________
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Socioafectiva:____________________________________________________________
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Cognitiva:_______________________________________________________________
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PERSONAL que INTERVINO en la ATENCIÓN del A.N.E.E.
Trabajador(a) Social Director(a) de C.A.M.
Instructor(a) de Taller Maestro(a) Especialista (Pedagogo)

PRIMARIA
1. DATOS GENERALES FECHA DE APERTURA DE ESTA EVALUACIÓN ______________

(señale con rojo en el dato que va a ampliar, modificar o agregue hojas)
A) DATOS PERSONALES
C.A.P.E.P.
Grupo de Apoyo
Preescolar Regular
Otra(s) Primaria(s) Regular(es)
Otro (especificar)
¿Ha REPROBADO algún GRADO?

Si No ¿Cuál? No. veces Motivo
Escuela (actual):______________________________________________________________________
Ciclo escolar: ______Grado:___ CICL. ESC. ______ GRADO _______ CICL. ESC. _____ GRADO
______
Maestro(a) de Grupo:_______________________ ______________________________
Maestro(a) de Apoyo:_______________________ ______________________________
B) DATOS FAMILIARES
TIPO de FAMILIA
FUNCIONAL SI NO DISFUNCIONAL SI NO marque con X
(Relaciones familiares armoniosas) (Relac. familiares SIN armonía) las opciones sig.
PADRE Nombre:___________________________________________ EDAD.:______________
Domicilio del Trabajo:____________________________________ Tels: ________________________
MADRE Nombre:_______________________________________________ EDAD:______________
Domicilio del Trabajo:____________________________________ Tels: ________________________
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a) instrumentos y técnicas
b) INTERPRETACIÓN de RESULTADOS


AULA CENTRO ESCOLAR
FAMILIA SOCIEDAD
c) DIAGNÓSTICO, SUGERENCIAS y/o ADECUACIONES para el APOYO que REQUIERE:
d) EVOLUCIÓN en las ESFERAS del DESARROLLO

Señale con una X
Motriz
Comunicativo
Socioafectivo
Cognitivo
e) EVOLUCIÓN y DESARROLLO en su COMPETENCIA CURRICULAR

Área o Fecha El alumno es Con ayuda, es Tipos de ayuda todavía NO es Nombre y
Asignat. capaz de hacer capaz de hacer que requiere capaz de hacer firma
f) ALCANCES OBTENIDOS al FINAL del CICLO ESCOLAR Fecha:__________________
GRADO:
1° 2° 3° 4° 5° 6°

Motriz
Comunicación:
Socioafectiva
Cognitiva:

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DEPARTAMENTO DE EDUCACIÓN ESPECIAL

EVALUACIÓN PSICOPEDAGÓGICA (FOTO)

Nombre del niño:__________________________________________________________ Sexo:______

Actitud de la familia ante el N.N.E.E.:_____________________________________________________

Otros familiares con N.E.E.:_____________________________________________________________

4. ANTECEDENTES del DESARROLLO

5. INSTRUMENTOS y/o TÉCNICAS APLICADAS

Instr. /Técnica Fecha Justificación Conducta Aplicador

INTERACCIONES que se ESTABLECEN en:

b) EVOLUCIÓN en las ESFERAS del DESARROLLO

Evolución y Fecha Por arriba Igual Por debajo Observaciones

NIVEL de COMPETENCIA CURRICULAR

LACTANTES: I II III MATERNAL: I II III

ÁREAS del DESARROLLO

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

Educador(a) Maestro(a) de Apoyo

Psicólogo(a) Maestro(a) en Comunicación

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

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

Nombre del niño:__________________________________________________________ Sexo:______

Actitud de la familia ante el N.N.E.E.:_____________________________________________________

Otros familiares con N.E.E.:_____________________________________________________________

4. ANTECEDENTES del DESARROLLO

5. INSTRUMENTOS y/o TÉCNICAS APLICADAS

Instr. /Técnica Fecha Justificación Conducta Aplicador

ESTILOS de APRENDIZAJE y MOTIVACIÓN para APRENDER

INTERACCIONES que se ESTABLECEN en:

b) EVOLUCIÓN en las ESFERAS del DESARROLLO

Evolución y Fecha Por arriba Igual Por debajo Observaciones

NIVEL de COMPETENCIA CURRICULAR

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

Educador(a) Maestro(a) de Apoyo

Psicólogo(a) Maestro(a) en Comunicación

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

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

Nombre del niño:__________________________________________________________ Sexo:______

¿Ha REPROBADO algún GRADO?

Actitud de la familia ante el N.N.E.E.:_____________________________________________________

Otros familiares con N.E.E.:_____________________________________________________________

4. ANTECEDENTES del DESARROLLO

Instr. /Técnica Fecha Justificación Conducta Aplicador

ESTILOS de APRENDIZAJE y MOTIVACIÓN para APRENDER

INTERACCIONES que se ESTABLECEN en:

b) EVOLUCIÓN en las ESFERAS del DESARROLLO

Evolución y Fecha Por arriba Igual Por debajo Observaciones

NIVEL de COMPETENCIA CURRICULAR

ESFERAS del DESARROLLO

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

Educador(a) Maestro(a) de Apoyo

Psicólogo(a) Maestro(a) en Comunicación

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

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

Nombre del alumno:_______________________________________________________ Sexo:______

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

Actitud de la familia ante el A.N.E.E.:_____________________________________________________

4. ANTECEDENTES del DESARROLLO

5. INSTRUMENTOS y/o TÉCNICAS APLICADAS

Instr. /Técnica Fecha Justificación Conducta Aplicador

ESTILOS de APRENDIZAJE y MOTIVACIÓN para APRENDER

INTERACCIONES que se ESTABLECEN en:

NIVEL de COMPETENCIA CURRICULAR

Evolución y Fecha Por arriba Igual Por debajo Observaciones

Evolución y Fecha Por arriba Igual Por debajo Observaciones

Nombre del niño:____________________________________________________ Sexo:

San Luis Potosí, S.L.P., a de _____________del_

Nombre del niño:____________________________________________________ Sexo:

San Luis Potosí, S.L.P., a de _____________del_

Nombre del niño:____________________________________________________ Sexo:

San Luis Potosí, S.L.P., a de _____________del_

Nombre del alumno:_________________________________________________ Sexo:

Nombre del alumno:_________________________________________________ Sexo:

Escuela (actual):_____________________________________ Fecha de Ingreso: _

TALLER: ____________ MÓDULO: PUESTO DE TRABAJO: _

San Luis Potosí, S.L.P., a de _____________del_