Informe de actividades.

Nombre estudiante: ________________________________________________________.

Curso: ___________. Edad: ___________. Fecha de nacimiento: ___________________.
P.I.E: SI - NO. NEE: _________________________________________________________.
Enfermedad mdica: _______________________________________________________.
Atencin psicolgica anterior: SI NO. Diagnstico:______________________________.
Apoderado(a):___________________________. Telfono apoderado(a): _____________.
Profesor(a) jefe: ___________________________.

Motivo de evaluacin:
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Actividades.

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