INFORME DE

EVALUACIN PSICOPEDAGGICA
PREESCOLAR
1. DATOS GENERALES
a) DATOS PERSONALES
Nombre del alumno: ______________________________________________________ Sexo:
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C.U.R.P.: _________________________ Fecha de nacimiento: _________ Edad: ___ aos ___
meses.
Domicilio: ______________________________________________Telfono:____________________
N.E.E.
asociadas
a____________________________________________
Clave:
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Servicio
Preescolar(es)

EXPERIENCIA EDUCATIVA
Perodo (meses y aos)

Contina asistiendo

Otro(s)
Regular(es)
C.A.P.E.P.
C.A.P.E.P. U.M.
Intervencin Temprana
C.A.M. Esc. de Educ. Esp.
Otra institucin
Del hogar

Escuela
(actual):______________________________________________________________________
Perodo
escolar:
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Grado:
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Grupo:__________
Nombre
del(a)
Educador(a):____________________________________________________________
Nombre
del(a)
Maestro(a)
de
Apoyo:
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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
familia:______________________________________________________________
Lugar que ocupa el nio entre sus hermanos:___________

la

PADRE
Nombre:
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Fecha
de
nac.:______________
Escolaridad:
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Ocupacin:
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Domicilio
del
Trabajo:
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Tel:
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MADRE
Nombre:
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Fecha
de
nac.:______________
Escolaridad:
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Ocupacin:
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Domicilio
del
Trabajo:
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Tel:
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Actitud de la familia ante el A.N.E.E.:_____________________________________________________

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Otros
familiares
con
N.E.E.:_____________________________________________________________
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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

Fecha

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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AULA

DIFICULTADES
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INTERACCIONES que se ESTABLECEN en:

CENTRO ESCOLAR

FAMILIA

SOCIEDAD

SUGERENCIAS y/o ADECUACIONES para el APOYO que REQUIERE:

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b) EVOLUCIN en las ESFERAS del DESARROLLO
Evolucin y
Desarrollo
Motriz
Comunicativo
Social
Cognitivo
Emocional

Fecha

Por arriba
A s
mismo

Del
grupo

Igual
A s
mismo

Del
grupo

Por debajo
A s
mismo

Del
grupo

Observaciones

c) EVOLUCIN y DESARROLLO en su COMPETENCIA CURRICULAR

Campos
Formativos

Fecha

El alumno es capaz de hacer

NIVEL de COMPETENCIA CURRICULAR

Con ayuda, el alumno es capaz de
Tipos de ayuda que requiere
hacer

El alumno todava NO es capaz de

hacer

Nombre y
firma

d) ALCANCES OBTENIDOS al FINAL del CICLO ESCOLAR

GRADO:

Fecha:__________________
3

C A M P O S
F O R M A T I V O S
Lenguaje y Comunicacin:
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Pensamiento Matemtico:
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Exploracin y Conocimiento del Mundo:

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Desarrollo Fsico y Salud:

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Desarrollo Personal y Social:

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Expresin y Apreciacin artsticas:

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

Educador(a)

Maestro(a) de Apoyo

Psiclogo(a)

Maestro(a) en Comunicacin

Trabajador(a) Social

Director(a) de C.A.P.E.P.

Director(a) del Jardn de Nios

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