INSTITUCIÓN EDUCATIVA N° 80096

“FRANCISCO BOLOGNESI”
- ESTUDIO - TRABAJO - SUPERACIÓN -

FICHA PSICOLÓGICA Y SOCIOEMOCIONAL

ACTIVIDAD ATENCIÓN PSICOLÓGICA Y EMOCIONAL

FORMATO

INFORMACIÓN GENERAL
Nombre de la IE: 80096 Francisco Bolognesi
Nombre y Apellidos:
Grado y sección:
Nivel:
Tutor:
Fecha de Atención
Entrevistadora: Ps. Cathia A. Mendieta Vasquez

INFORMACIÓN PERSONAL
Edad: Padre:
Fec. de nacimiento: Madre:
N° hermanos: Otro familiar:
Vive con:
Dirección
Número de celular:
MOTIVO DE CONSULTA
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RECOJO DE INFORMACIÓN DEL ESTADO EMOCIONAL:

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RECOMENDACIONES
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 INSTITUCIÓN EDUCATIVA N° 80096
“FRANCISCO BOLOGNESI”
- ESTUDIO - TRABAJO - SUPERACIÓN -

SEGUIMIENTO

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SEGUIMIENTO

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SEGUIMIENTO

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SEGUIMIENTO

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 INSTITUCIÓN EDUCATIVA N° 80096
“FRANCISCO BOLOGNESI”
- ESTUDIO - TRABAJO - SUPERACIÓN -