INFORME PSICOPEDAGÓGICO N°

TEST APLICADO:…………………………………………………………….

1. DATOS DE FILIACION

NOMBRES Y APELLIDOS:

EDAD:
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SEXO.
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LUGAR Y FECHA DE NACIMIENTO
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GRADO DE INSTRUCCIÓN
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RELIGIÓN.
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IDIOMAS QUE HABLAN
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N° DE HERMANOS.
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LUGAR ENTRE HERMANOS
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RESIDENCIA ACTUAL
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PERSONA RESPONSABLE DEL PACIENTE
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NOMBRE DE LOS PADRES

NOMBRE DE LA MADRE
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NOMBRE DEL PADRE

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FECHA DE EVALUACION
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NOMBRE DEL EXAMINADOR

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II. OBSERVACIÓN DE LA CONDUCTA

RASGOS FÍSICOS

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RASGOS PSICOLÓGICOS

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SITUACIÓN PROPIA DEL TEST

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III. RESULTADOS E INTERPRETACIÓN

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IV. CONCLUSIONES Y RECOMENDACIONES PSICOLÓGICAS

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IV. CONCLUSIONES Y RECOMENDACIONES PSICOLÓGICAS

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 INTERVENCIÓN PSICOPEDAGÓGICA

CON PARA RECURSO MEDIOS DE

ACTIVIDADES DONDE CUANDO POR QUE
QUIEN QUE MATERIALES HUMANOS VERIFICACIÓN
Sugerencias

Foto de la persona examinada en 4x4

Peso y talla del paciente

Ocupación de los padres