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 Nr...................din.......................

Director executiv adj.

  RAPORT DE EVALUARE INIŢIALĂ

 NUME PRENUME COPIL

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.................................................................................................…………………………………....................CNP/ DATA NAŞTERII...........................................................……………………………………………………………………….. NUME/ PRENUME PĂRINŢI........................................................................................................................................………………..........DATA NAŞTERII.....................................................................................................................................................................DOMICILIUL PĂRINŢILOR.......................................................................................………………..........SESIZARE EMISĂ DE.................................................................................................………………..........DACĂ A MAI FOST ÎN ATENŢIA INSTITUŢIEI NOASTRE (pri!"d"# pr!$%&"# &')ri %)"*+

………………………………………………………………………………………………………………DATA ŞI LOCUL ÎNTREVEDERII..............................................................................………………..........DURATA DISCUŢIEI...................................................................................................…………………......PERSOANELE PARTICIPANTE.............................……………………………………………………...........................................................………………………………..........................................................................................................................CONSTATĂRI LA MOMENTUL EVALUĂRII.....................................................................……………………………………………………..................………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

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RELAŢIA COPIL/FAMILIA NATURALĂCOMPORTAMENTUL COPILULUI (dacă părinii acceptă !i "ac "aă copi#u#ui$ trata%entu#ap#icat&………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

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………………………………………………………………………………………………………………………………………………………………………………………………………………………………COMPORTAMENTUL P'RINILOR (d",' -i*' r%"ii d ",i)n# "*"0"&n* r,ipr!,# d",',!pi%)% pr1in*' &n d "$)1 ") n2%i3"r+………………………………………………………….................................................………………….………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………IDENTI)ICAREA NE*OILOR COPILULUI+COPIILOR

………………………………………………….................................................................................................................................................…………………………………………………………………………………………………………………………………………………………………………………………CONDIII DE LOCUIT (i2in'# p"i)# d!*'ri# i2in' pr!"n%' " ,!pi%)%)i *,+........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ *ENITURILE )AMILIEI…………………………………………………………..............................................................................

............................................................................................................................................................................................................................................................................................................................................ALIMENTAIA COPILULUI………………………………………………………………………………….......................................................................……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….......,TAREA DE ,'N'TATE A COPILULUI  (d",' * 4n,ri i" &di,)% d "&i%i# di"2n!*i,#5",,in'ri# 2r)*"*# "%*  pr!$%&....+……………………...................................………………………………………………………………….

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………,TAREA DE ,'N'TATE A P'RINILOR (d",' ") 2r"d d 6"ndi,"p# d",' ") pr!$%& pi6i,#di"2n!*i,.+………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

,ITUAIA -COLAR' (, !r&' d 0,!%"ri1"r r,5n*"1'+…………………………………...........................................................................................………..........................................................................................…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………. .......................................................................................

OPINIA COPILULUI (4n ,. d 57r*" 0i d15!%*"r" &n*"%'+……………………………………………...........................................................................................…..........................................................................................

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…………………………………………………………………………….............................................................................................................................................CONCLU1II (i1"r" inir&' ") ,!nir&' "$)1)% ") n2%i3"r"+…………………………………….............................................................................................................................................................................................................………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….RECOMAND'RI+O2,ER*AII ALE RE,PON,A2ILULUI DE CA1………………………………………..........................................................................................................

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………...................RE,PON,A2IL DE CA1 D/A,PC (nu%e+prenu%e$ "uncia&……………………………………………………………………………………………………….........

SEMNEAZĂ8Rpr1n*"ni "i D9ASPC S),"5"..............................................

Rpr1n*"ni Pri&'ri..................................................................

Rpr1n*"ni P!%ii.....................................................................

Vi1"*8 0 r5i,i)

F"&i%i" N"*)r"%'8 M"&"....................................T"*".................................................

A%* r)d/pr!"n *r'in