DEPARTAMENTO DE EDUCACIÓN ESPECIAL

EVALUACIÓN PSICOPEDAGÓGICA
PRIMARIA
1. DATOS GENERALES
a) DATOS PERSONALES

Nombre del niño:__________________________________________________________ Sexo:______

C.U.R.P.: __________________________ Fecha de nacimiento:_________ Edad:___ años ___
meses.
Domicilio:___________________________________________________Teléfono:________________N.E.
E. asociadas a______________________________________________ Clave:_________________

EXPERIENCIA EDUCATIVA
Servicio Período (meses y años) Continúa asistiendo
Intervención Temprana
C.A.P.E.P.
Grupo de Apoyo
Preescolar Regular
Otra(s) Primaria(s)
Regular(es)
Centro Psicopedagógico
Esc. de Educ Especial o
C.A.M.
Otro (especificar)

¿Ha REPROBADO algún GRADO?

Si N ¿Cuál No. de Motivo
o ? veces

Escuela (actual):______________________________________________________________________
Ciclo escolar: _______________________________________Grado:___________ Grupo:__________
Nombre del(a) Maestro(a) de Grupo:_____________________________________________________
Nombre del(a) Maestro(a) de Apoyo:_____________________________________________________

b) DATOS FAMILIARES

TIPO de FAMILIA
FUNCIONAL (Relaciones DISFUNCIONAL (Relaciones
familiares armoniosas)) familiares SIN armonía)
NUCLEAR [Conformada solamente por padre, madre e hijo(s)]
EXTENSIVA (Cuando hay más parientes agregados)
MIXTA (Cuando existe padrastro o madrastra)
DE UN SOLO PADRE (Cuando el padre o madre solo, es soltero, viudo o
divorciado)

Composición de la familia:______________________________________________________________
Lugar que ocupa el niño entre sus hermanos:___________

PADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupación:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________

MADRE
Nombre:__________________________________________________ Fecha de nac.:______________
Escolaridad:______________________________ Ocupación:__________________________________
Domicilio del Trabajo:____________________________________________ Tel: _________________

Actitud de la familia ante el N.N.E.E.:_____________________________________________________

___________________________________________________________________________________________
___________________________________________________________________________

1
Otros familiares con N.E.E.:_____________________________________________________________

2. MOTIVO de la EVALUACIÓN
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________

3. APARIENCIA FÍSICA
__________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________________

4. ANTECEDENTES del DESARROLLO

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________________________________

5. INSTRUMENTOS y/o TÉCNICAS APLICADAS

Instr. /Técnica Fech Justificación Conducta Aplicador

a

2
a) INTERPRETACIÓN de RESULTADOS

ESTILOS de APRENDIZAJE y MOTIVACIÓN para APRENDER

¿Cómo aprende el alumno? ¿Qué es lo que le motiva a aprender?

CAPACIDADES DIFICULTADES
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________

3
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
____________________________________________ ____________________________________________
___________________________ ___________________________

INTERACCIONES que se ESTABLECEN en:

AULA CENTRO ESCOLAR

FAMILIA SOCIEDAD

DIAGNÓSTICO, SUGERENCIAS y/o ADECUACIONES para el APOYO que REQUIERE:

___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

4
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________________________________

b) EVOLUCIÓN en las ESFERAS del DESARROLLO

Evolución y Fech Por arriba Igual Por debajo Observaciones

Desarrollo a A sí Del A sí Del A sí Del
mism grupo mism grupo mism grupo
o o o
Motriz

Comunicativ
o

Socioafectiv
o

Cognitivo

5
c) EVOLUCIÓN y DESARROLLO en su COMPETENCIA CURRICULAR

NIVEL de COMPETENCIA CURRICULAR

Área o Fech El alumno es capaz de hacer Con ayuda, el alumno es capaz Tipos de ayuda que requiere El alumno todavía NO es Nombre y
Asignatur a de hacer capaz de hacer firma
a
d) ALCANCES OBTENIDOS al FINAL del CICLO ESCOLAR Fecha:__________________

GRADO:

1° 2° 3° 4° 5° 6°

ESFERAS del DESARROLLO

Motriz:___________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________

Comunicación:__________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________

Socioafectiva:___________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_______
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________

Cognitiva:_______________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
__

6. CONCLUSIONES y RECOMENDACIONES
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________

7
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________

PERSONAL que INTERVINO en la ATENCIÓN del N.N.E.E.

Educador(a) Maestro(a) de Apoyo

Psicólogo(a) Maestro(a) en Comunicación

Trabajador(a) Social Director(a) de U.S.A.E.R.

Director(a) de Escuela Primaria

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