INSTITUCIN EDUCATIVA CRISTIANA

INTERNACIONAL ELIM

FICHA PSICOPEDAGGICA

Fecha de Evaluacin: ___/___/_____

DATOS DE FILIACIN:

Nombres y Apellidos: __________________________________________________Edad: ___________________

Fecha y Lugar de Nac: ___________________________ Cel: ____________ Religin: ___________________
Padre:__________________________Edad:_______Ocupacin:__________________Telfono:______________
Madre__________________________Edad:_______Ocupacin:__________________Telfono:______________
Grado:__________________Tutor(a)_______________________Hermanos:______________________________
Direccin: ________________________________________________________________________________
Estado civil de los padres: _______________________________

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MOTIVO DE CONSULTA
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ANTECEDENTES PERSONALES Y FAMILIARES

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RESULTADOS DE LAS EVALUACIONES:

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RECOMENDACIONES:
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Formando Alumnos con Futuro
INSTITUCIN EDUCATIVA CRISTIANA
INTERNACIONAL ELIM

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Departamento de
Psicopedagoga

Formando Alumnos con Futuro