AVALIAO INICIAL DO PROCESSO DE ENSINO APRENDIZAGEM

ANOS INICIAIS
1. Dados de Identificao
Nome : _________________________________________________________________________
Data de Nascimento: ____ / ____ / ________ Idade __________anos
Filiao: Pai : ____________________________________________________________________
Me:
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Responsvel:____________________________________________________________________
Endereo: ______________________________________________________________________
Telefone:________________________________________________________________________
Unidade Educacional:______________________________________________________________
Professora:______________________________________________________________________
Pedagoga:______________________________________________________________________
Diretor(a):_______________________________________________________________________
Ano Escolar :_____________ Turno: Manh ( ) Tarde ( )

2. Histrico Escolar
Ano Nome da Unidade Educacional Ano Turno
Letivo Escolar

2.1.Histrico de frequncia escolar:

( ) Assduo ( ) Faltoso

3. Motivo do Encaminhamento para Avaliao (Queixa Escolar)

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3.1.Aes realizadas pela escola frente as questes apresentadas:

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4. Dificuldades nas seguintes reas (suspeitas)

Visual: ( ) Usa culos? ( ) Lentes de contato? ( ) Outros________________________________
Auditiva: ( ) Usa aparelho auditivo? ( ) Outros_________________________________________
Fsica: ( ) Usa Muletas? ( ) Cadeira de rodas ( ) Prteses? Qual? ________________________
Outros / Obs: ( ) _________________________________________________________________

5. rea socioemocional (registrar questes referentes ao comportamento: interao com os

colegas, disciplina, autoestima, autonomia, tolerncia a frustaes, insegurana, ansiedade)
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6. rea Psicomotora (Esquema corporal, lateralidade, orientao espacial e temporal e

coordenao motora)
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7. Funes Psicolgicas Superiores (Linguagem, ateno, memria, raciocnio)

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8. rea Acadmica (Descrever as apropriaes e dificuldades do aluno)

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9. Informaes complementares e relevantes ( dados atuais referentes famlia, sade,

medicamentos utilizados, situao scio-econmica, etc.)
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