UNITATEA SCOLARA :

FIA DE EVALUARE COMPLEX

Trimis de _____________________________________

Motivul trimiterii_______________________________ANCHETA SOCIALDate generale i familiale: Nume_______________________Prenume_____________________________________________

Data naterii________________Locul naterii___________Domiciliul________________________

_________________________________________________________________________________Tatl (nume, prenume, profesie, loc de munc)__________________________________________

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Mama (nume, prenume, profesie, loc de munc)__________________________________________________________________________________________________________________________

Condiii de locuit_________________________________________________________________

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Relaiile ntre prini_______________________________________________________________

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Relaiile ntre prini i copii___________________________________________________________________________________________________________________________________________

Atitudinea prinilor fa de educaia copilului____________________________________________

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Surse de venit_______________________________________________________________________________________________________________________________________________________

Influene ambientale_______________________________________________________________ _______________________________________________________________________________

Meniuni speciale___________________________________________________________________

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Data _______________ ntocmit de: ___________________ Semntura ______________

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