Ministero della Pubblica Istruzione
ISTITUTO COMPRENSIVO STATALE SAN VERO MILIS
Via Umberto I, 12 - 09070 San Vero Milis (OR) - C.M. ORIC81200V - CF 90027760959
Tel. 0783-53670, Fax 0783/558128
SCUOLA ……………. DI
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ANNO SCOLASTICO 2014 /2015
PIANO EDUCATIVO INDIVIDUALIZZATO
PER L’ANNO SCOLASTICO 201-/201-
ALUNN___:
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ISCRITT___ ALLA CLASSE ____
Insegnante/i di sostegno: ___________________________________________________
PROFILO PERSONALE DELL’ALUNN___
Nome: _______________________________ Cognome: ___________________________
Data di nascita: ________________________ Luogo: _____________________________
Residenza: ____________________________ Telefono: ___________________________
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Quadro familiare
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Cognome e nome
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Luogo e data di nascita
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Titolo di studio
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Professione
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PROFILO DIDATTICO
Esperienze scolastiche precedenti e attuali
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Insegnanti della classe
Cognome e nome
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Ambito disciplinare
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Ore di sostegno assegnate nel corrente anno scolastico
La Scuola è in possesso della diagnosi funzionale
La Scuola è in possesso della certificazione medica
SALUTE E FUNZIONAMENTO
Diagnosi
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(Dalla Diagnosi Funzionale rilasciata, in data _________, da____ Neuropsichiatra infantile: _______________________)
Condizioni fisiche (malattie varie, disturbo o malattia acuta o cronica, situazioni cromosomiche particolari, lesioni…..)
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(Dalla Diagnosi rilasciata, in data ___________, dal Medico Specialista: _______________________________________)
Strutture corporee (integrità delle strutture corporee o eventuali menomazioni che causano limitazioni nelle capacità e/o
influiscono nella partecipazione, strutture del sistema nervoso, strutture dell’occhio e dell’orecchio,
strutture collegate al movimento, strutture coinvolte nell’eloquio………)
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(Dalla Diagnosi rilasciata, in data ___________, dal Medico Specialista: _______________________________________)
Funzioni corporee (funzioni mentali, funzioni sensoriali, funzioni della voce e dell’eloquio…..)
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Area cognitiva e neuropsicologica
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PARTECIPAZIONE SOCIALE
Fattori Contestuali Ambientali
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Esperienze educative extrascolastiche precedenti e attuali, tempo libero
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Fattori Contestuali Personali
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Area del sè, autostima, gestione delle emozioni, motivazione
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Integrazione, relazionalità e partecipazione
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ATTIVITÀ PERSONALI
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Apprendimento e applicazione delle conoscenze (difficoltà di apprendimento, di applicazione delle conoscenze, di comunicazione, limiti nell’esecuzione delle attività e nella partecipazione)
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Area linguistico espressiva - Comunicazione
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BISOGNI EDUCATIVI SPECIALI
(Obiettivi formativi a BREVE - MEDIO E LUNGO TERMINE)
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PROPOSTA DIDATTICO - EDUCATIVA
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Attività tecniche e mezzi
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Spazi utilizzati per la realizzazione dell’intervento educativo-didattico
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Modalità di verifica degli obiettivi individuati
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Data __________________________
Insegnanti della classe
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Genitori
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