io REPUBLIQUE DU CAMEROUN REPUBLIC OF CAMEROON

Paix –Travail – Patrie Peace – Work – Fatherland

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REGION DU CENTRE CENTER REGION
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DELEGATION REGIONALE DES AFFAIRES SOCIALES REGIONAL DELEGATION OF SOCIAL AFFAIRS
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DELEGATION DEPARTEMENTALE DES AFFAIRES DIVISIONAL DELEGATION OF SOCIAL AFFAIRS
SOCIALES DU MFOUNDI FOR MFOUNDI
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CENTRE SOCIAL DE YAOUNDE V- ESSOS SOCIAL CENTER OF YAOUNDE V

N°2022/ /RES/RC/DRAS/DDAS-MFDI/CESO-YDE V

Yaoundé, le…………………….

RAPPORT D’ENQUETE SOCIALE

Concernant :

Object :

I - IDENTIFICATION :
Nom et prénom :______________________________________________
Date et lieu de naissance : __________________________________________
Région d’origine : _________________________________________________
Département : ____________________________________________________
Arrondissement : __________________________________________________
Ethnie : _________________________________________________________
Etablissement fréquenté : ___________________________________________
Niveau d’études : _________________________________________________
Etablissement sollicité : _____________________________________________
Classe sollicitée : __________________________________________________
Profession : _____________________________________________________
Religion : ________________________________________________________
Antécédents judiciaires : ____________________________________________
Antécédents médicaux : _____________________________________________
Situation sociale : ________________________________________________
Résidence : _______________________________________________________
Adresse/contact : _________________________________________________
II – COMPOSITION DE LA FAMILLE
A - Parents :

Père : ______________________________________________________________
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Mère : ______________________________________________________________
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b-Fratrie :

N° NOMS ET Age Situation Profession Lieu de

PRENOMS matrimoniale résidence

01

02

03

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06

07

08

09

10

III – CONDITIONS MATERIELLES ET FINANCIERES DE VIE

a – Conditions matérielles
- Le cadre de vie
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- L’environnement
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c) – Conditions financières
- Ressources
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IV - HISTOIRE DE VIE DE L’INTERESSE(E)

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Situation problème
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 V - ANALYSE ET SUGGESTIONS

A) ANALYSE
Sur le plan physique
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Sur le plan familial et social

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Sur le plan psychologique

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Sur le plan scolaire

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Sur le plan matériel et financier

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VI- SUGGESTIONS

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Le Chef de Centre L’Enquêteur