ANCHETA SOCIALĂ
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ANCHETA SOCIALĂ Realizată de asistentul social_____________________________________ Locul şi data__________________________________________________ Persoane prezente_____________________________________________ Scopul_____________________________________________________ I. Date de identificare a beneficiarului Nume şi prenume:_____________________________________________ Locul şi data naşterii:___________________________________________ CNP:__/__/__/__/__/__/__/__/__/__/__/__/__/ C.I._____________________ Domiciliul legal:______________________________________________ Domiciliul în fapt:_____________________________________________ Stare civilă:__________________________________________________ Studii:______________________Ocupaţia: _____________________ Etnia:__________________________ Religia:________________________________ II. Date despre familie: Date despre mama(soţia) Nume şi prenume:_____________________________________________ Locul şi data naşterii:___________________________________________ CNP:__/__/__/__/__/__/__/__/__/__/__/__/__/ C.I._____________________ Domiciliul legal:______________________________________________ Domiciliul în fapt:_____________________________________________ Stare civilă:__________________________________________________
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ANCHETA SOCIALA
Transcript of ANCHETA SOCIALĂ
ANCHETA SOCIAL
ANCHETA SOCIAL
Realizat de asistentul social_____________________________________
Locul i data__________________________________________________
Persoane prezente_____________________________________________
Scopul_____________________________________________________
I. Date de identificare a beneficiarului
Nume i prenume:_____________________________________________
Locul i data naterii:___________________________________________
CNP:__/__/__/__/__/__/__/__/__/__/__/__/__/ C.I._____________________
Domiciliul legal:______________________________________________
Domiciliul n fapt:_____________________________________________
Stare civil:__________________________________________________
Studii:______________________Ocupaia: _____________________
Etnia:__________________________ Religia:________________________________
II. Date despre familie:
Date despre mama(soia)
Nume i prenume:_____________________________________________
Locul i data naterii:___________________________________________
CNP:__/__/__/__/__/__/__/__/__/__/__/__/__/ C.I._____________________
Domiciliul legal:______________________________________________Domiciliul n fapt:_____________________________________________
Stare civil:__________________________________________________
Studii:_________________________Ocupaia:______________________
Etnia:____________________________Religia:_____________________
Date despre tata(soul)
Nume i prenume:____________________________________________
Locul i data naterii:___________________________________________
CNP:__/__/__/__/__/__/__/__/__/__/__/__/__/ B.I._____________________
Domiciliul legal:______________________________________________
Domiciliul n fapt:_____________________________________________
Stare civil:__________________________________________________
Studii:_________________________ Ocupaia:_____________________
Etnia:___________________________Religia:______________________
Date despre copiii din familie
Nr.crtNume si prenumeData nasteriiOcupatia
Locul unde se afla copilul:familie/instituieObservaii
1
2
3
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5
Date despre alte persoane care locuiesc la aceeai adresNr.crtNume i prenumeVrstaStare civilOcupaie
1
2
3
III. Istoricul social al beneficiarului________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________IV. Starea de sntate_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________V. Situaia material/financiar
Locuina
Proprietate personal: ( da ( nu
Numarul de camere:_______ Electricitate Ap curent nclzire
Telefon
Starea de igien:
Satisfctoare Nesatisfctoare
Suprafaa de teren cultivat (tipul culturii):________________________
Animale:_____________________________________________________
Alte proprieti:_______________________________________________
Venituri
Stabile:_____________________________________________________
Ocazionale:__________________________________________________
VI. Relaiile n familie i comunitate
Relaii n familie:_________________________________________________________________________________________________________________________Relaiile n comunitate________________________________________________________________________________________________________________
VII. Observaii
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Concluzii i recomandri________________________________________________________________________________________________________________________________________________ ________________________________________________________________________
Asistent Social
