Бланк выписки из истории развития ребенка на пмпк

_                                                         Шапка                                                                

                                               (наименование учреждения)

Характеристика

1. Общие сведения:

Фамилия, имя, отчество ребенка:                                                                                                                                                                                

Дата рождения ребенка:                                                                                

Адрес регистрации по месту жительства:                                                                                                                                                                                                                                                                         

Адрес фактического проживания:                                                                                                                                                                                                                                                                                        

Сведения о родителях (законных представителях):                                                                                                                                                                                                                                                                                                                                                                         

С кем проживает ребенок:                                                                                                                                                                                        

Контактная информация семьи:                                                                                                                                                                                                                                                                                        

2. История обучения ребенка до обращения на ЦПМПК:

Обучался ли где-либо до поступления в эту образовательную организацию:                                                                                                                                

Оставался ли на второй год, в каких классах:                                                                                                                                                                

Причины перевода из другой образовательной организации:                                                                                                                                                                                                                                                         

3. Детализированная информация об условиях и результатах обучения ребенка в образовательной организации:

Класс:                                                                                                        

Программа обучения:                                                                                                                                                                                        

Форма обучения:                                                                                                                                                                                                 

Возраст поступления в образовательную организацию, степень подготовленности:                                                                                                                        

Сколько времени находится ребенок в данной образовательной организации:                                                                                                                        

Особенности адаптации ребенка к данной образовательной организации:                                                                                                                                

Отношение к учебной деятельности:                                                                                                                                                                        

Отношение ребенка к словесной инструкции педагога (реакция на нее):                                                                                                                                

Сформированность учебных навыков:                                                                                                                                                                                                                                                                                

Как успевает ребенок, в чем заключаются особенности или трудности усвоения им программы:                                                                                                                                                                                                                                                                                                                

Характер ошибок (отдельно по математике, письму, чтению и другими предметами):                                                                                                                                                                                                                                                                                                                                                                                                                                         

Развитие моторики и речи:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         

4. Соответствие объема школьных знаний, умений и навыков требованиям программы с оценкой динамики обученности:

Математика:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         

Чтение:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

Письмо                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

Другие предметы:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         

Описать в чем вероятная причина недостатков в обучении:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         

5. Характеристика обучаемости:

Какие виды помощи использует учитель:                                                                                                                                                                                                                                                                                                                                                                                 

Насколько эффективна помощь (недостаточная, низкая):                                                                                                                                                                                                                                                         

Информация о соблюдении учебной дисциплины:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 

6. Для младших школьников:

Указать степень готовности ребенка с которой он пришел в школу и какую динамику дал в процессе обучения:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

7. Для учеников подросткового возраста: 

С какого года обучения (класса) проблемы стали очевидными:                                                                                                                                        

В чем проблемы заключались:                                                                                                                                                                                 

Сведения o формальной успеваемости по основным предметам:                                                                                                                                        

Частоты и характера конфликтов с соучениками, педагогами, поведения в конфликте, проявлений переживаю/ий по поводу конфликтов:                                                                                                                                                                                                                                                                  Перечислить основные проступки, вызвавшие тревогу у педагогов:                                                                                                                                        

Указать, с обучающимися какого возраста предпочитает общаться (младшими, старшими, своего возраста):                                                                                                                                                                                                 

Охарактеризовать интересы, увлечения:                                                                                                                                                                                                                                                                                 

7. Для ребенка любого возраста:

 Сведения о работоспособности ребенка:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          

Уровень общего развития:                                                                                                                                                                                         

Общая осведомленность ребенка о себе:                                                                                                                                                                                                                                                                                 

Взаимоотношение обучающегося с коллективом сверстников:                                                                                                                                                                                                                                                 

Какие меры коррекции применялись, и их эффективность:                                                                                                                                                                                                                                                         

Особенности семейного воспитания:                                                                                                                                                                                                                                                                                 

Отношение самого ребенка и его семьи к имеющимся проблемам и трудностям:                                                                                                                                                                                                                                                                                                                                         

Возможности ребенка, на которые можно опираться в педагогической работе, а также обобщенные выводы педагога и его пожелания по организации дальнейшего обучения ребенка:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 

Цель составления документа:                                                                                                                                                                                                                                                                                                                                                                                                 

МП

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