Ministero della Pubblica Istruzione

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. [phone], Fax [phone]
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: ___________________________

Quadro familiare

Grado di parentela	Cognome e nome	Luogo e data di nascita	Titolo di studio	Professione

PROFILO DIDATTICO
Esperienze scolastiche precedenti e attuali
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Insegnanti della classe

Cognome e nome	Ambito disciplinare

Ore di sostegno assegnate nel corrente anno scolastico

si	no
si	no

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…..)

• 
  Area cognitiva e neuropsicologica
  

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• 
  Area senso-percettiva
  

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• 
  Area psicomotoria
  

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PARTECIPAZIONE SOCIALE
Fattori Contestuali Ambientali

• 
  Esperienze educative extrascolastiche precedenti e attuali, tempo libero
  

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• 
  Abilità sociali
  

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Fattori Contestuali Personali

• 
  Area del sè, autostima, gestione delle emozioni, motivazione
  

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• 
  Integrazione, relazionalità e partecipazione
  

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ATTIVITÀ PERSONALI

• 
  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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• 
  Autonomia personale
  

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• 
  Autonomia scolastica
  

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• 
  Area logico-matematica
  

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• 
  Area linguistico espressiva - Comunicazione
  

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• 
  Area antropologica
  

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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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• 
  Sussidi didattici
  

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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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