DEPARTAMENTO DE EDUCACIN ESPECIAL

INFORME DE
EVALUACIN PSICOPEDAGGICA

CAPACITACIN LABORAL
1. DATOS GENERALES
a) DATOS PERSONALES
Nombre del alumno:_______________________________________________________ Sexo:______
C.U.R.P.: __________________________ Fecha de nacimiento:_________ Edad:___ aos ___
meses.
Domicilio:___________________________________________________Telfono:________________N.E.E
. asociadas a______________________________________________ Clave:_________________
Servicio
Intervencin Temprana
C.A.P.E.P.
Grupo de Apoyo
Preescolar Regular
Primaria Regular
Otra(s)
Secundaria(s)
Regular(es)
Centro Psicopedaggico
Esc. de Educ Especial o
C.A.M.
Otro (especificar)

Si

No

EXPERIENCIA EDUCATIVA
Perodo (meses y aos)

Contina asistiendo

Ha REPROBADO alguna(s) MATERIA(S) TODO un GRADO?

Grad No. de
Materia
Motivo
o

veces

Escuela (actual):_____________________________________________ Fecha de Ingreso: _________

Ciclo escolar: ____________ Taller: ____________________ Mdulo: _________ Puesto:__________
Nombre del(a) Instructor(a) de Taller: ____________________________________________________
b) DATOS FAMILIARES
TIPO de FAMILIA
FUNCIONAL
(Relaciones
DISFUNCIONAL (Relaciones
familiares armoniosas)
familiares SIN armona)
NUCLEAR [Conformada solamente por padre, madre e hijo(s)]
EXTENSIVA (Cuando hay ms parientes agregados)
MIXTA (Cuando existe padrastro o madrastra)
DE UN SOLO PADRE (Cuando el padre o madre solo, es soltero, viudo o
divorciado)
Composicin de la familia:______________________________________________________________
Lugar que ocupa el(la) joven entre sus hermanos:___________
PADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupacin:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
MADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupacin:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________
Actitud de la familia ante el A.N.E.E.:_____________________________________________________
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Otros familiares con N.E.E.:_____________________________________________________________

2. MOTIVO de la EVALUACIN
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3. APARIENCIA FSICA
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4. ANTECEDENTES DEL DESARROLLO

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5. INSTRUMENTOS y/o TCNICAS APLICADAS

Instr. /Tcnica

Fech
a

Justificacin

Conducta

Aplicador

a) INTERPRETACIN de RESULTADOS
ESTILOS de APRENDIZAJE y MOTIVACIN para APRENDER
Cmo aprende el alumno?
Qu es lo que le motiva a aprender?

CAPACIDADES
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DIFICULTADES
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INTERACCIONES que se ESTABLECEN en:

TALLER: _______________________
CENTRO ESCOLAR

FAMILIA

SOCIEDAD

SUGERENCIAS y/o ADECUACIONES para el APOYO que REQUIERE:

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EVOLUCIN en las ESFERAS del DESARROLLO en EDUCACIN

EDUCACIN ARTSTICA ACTIVIDADES COMPLEMENTARIAS

FSICA,

TALLER: ____________________ MDULO: ________ PUESTO DE TRABAJO: _________

Evolucin y
Desarrollo

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Observaciones

Del
grupo

MOTRIZ
rea, Asig.
Activ. Compl.:
____________
MOTRIZ
rea, Asig.
Activ. Compl.
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MOTRIZ
rea, Asig.
Activ. Compl.:
____________
MOTRIZ
rea, Asig.
Activ. Compl.:
____________
Evolucin y
Desarrollo

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Observaciones

Del
grupo

COMUNICATIV
O

rea, Asig.
Activ. Compl.
____________
COMUNICATIV
O rea, Asig.

Activ.
Compl.
____________

COMUNICATIV
O rea, Asig.

Activ.
Compl.
____________
COMUNICATIV
O rea, Asig.

Activ.
Compl.
____________

Evolucin y
Desarrollo
SOCIAL

rea, Asig.
Activ. Compl.
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SOCIAL

rea, Asig.
Activ. Compl.
____________
SOCIAL

rea, Asig.
Activ. Compl.
____________
SOCIAL

rea, Asig.
Activ. Compl.
____________
SOCIAL

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Del
grupo

Observaciones

rea, Asig.
Activ. Compl.
____________

Evolucin y
Desarrollo

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Observaciones

Del
grupo

EMOCIONAL
rea, Asig.
Activ. Compl.
____________
EMOCIONAL
rea, Asig.
Activ. Compl.
____________
EMOCIONAL
rea, Asig.
Activ. Compl.
____________
EMOCIONAL
rea, Asig.
Activ. Compl.
____________
EMOCIONAL
rea, Asig.
Activ. Compl.
____________
EMOCIONAL
rea, Asig.
Activ. Compl.
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EMOCIONAL
rea, Asig.
Activ. Compl.
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Evolucin y
Desarrollo
COGNITIVO
rea, Asig.
Activ. Compl.
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COGNITIVO
rea, Asig.
Activ. Compl.
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COGNITIVO
rea, Asig.
Activ. Compl.
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COGNITIVO
rea, Asig.
Activ. Compl.
____________
COGNITIVO
rea, Asig.
Activ. Compl.
____________
COGNITIVO
rea, Asig.
Activ. Compl.
____________
COGNITIVO
rea, Asig.
Activ. Compl.
____________

Fech
a

Por arriba
De s
mism
o

Del
grupo

Igual
A s
mism
o

Al
grupo

Por debajo
De s
mism
o

Del
grupo

Observaciones

c) EVOLUCIN y DESARROLLO en su COMPETENCIA CURRICULAR

Mdulo y
Puesto de
Trabajo

Fech
a

NIVEL de COMPETENCIA CURRICULAR, en el TALLER: _________________________________

El alumno es capaz de
Con ayuda, el alumno es capaz Tipos de ayuda que requiere
El alumno todava NO es
hacer
de hacer
capaz de hacer

Nombre y
firma

d) ALCANCES OBTENIDOS al FINAL del CICLO ESCOLAR

TALLER:

MDULO
:

Fecha:__________________

PUESTO DE
TRABAJO:

ESFERAS del DESARROLLO

Motriz:___________________________________________________________________________________
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Comunicacin:__________________________________________________________________________
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Social:___________________________________________________________________________________
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Emocional:______________________________________________________________________________
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Cognitiva:_______________________________________________________________________________
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6. CONCLUSIONES y RECOMENDACIONES
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PERSONAL que INTERVINO en la ATENCIN del A.N.E.E.

Maestro(a) de Capacitacin Laboral

Maestro(a) Especialista

Psiclogo(a)

Maestro(a) en Comunicacin

Trabajador(a) Social

Director(a) de C.A.M. Bsico y/o Laboral

San Luis Potos, S.L.P., a ______de _________________________________del_______________

6. CONCLUSIONES y RECOMENDACIONES
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PERSONAL que INTERVINO en la ATENCIN del A.N.E.E.

Maestro(a) de Capacitacin Laboral

Maestro(a) Especialista

Psiclogo(a)

Maestro(a) en Comunicacin

Trabajador(a) Social

Director(a) de C.A.M. Bsico y/o Laboral

Director(a) de la Institucin

San Luis Potos, S.L.P., a ______de _________________________________del_______________