ࡱ> DFCcL<bjbjzz.@~]\~]\d: :  $`     giiiiii$!r  ///  g/g/// `6/S00`/D"4D"/D"/$//`D": R :...................................... Ostrw Wielkopolski, dn. & & & & & & & piecztka szkoBy Wniosek Dyrektora o przeprowadzenie diagnozy i wskazanie sposobu rozwizania problemu ucznia zgodnie z Rozporzdzeniem MEN z dnia 9 sierpnia 2017r. I. Dane osobowe dziecka/ucznia: ........................................................................... ............................................................. imi i nazwisko PESEL & .............................................................................................................................................................................................................................. data i miejsce urodzenia .................................................................................................................................................................................................................................. adres zamieszkania dziecka/ucznia .................................................................................................................................................................................................................................. nazwa i adres przedszkola/szkoBy/o[rodka , klasa ....................................................................................................................................................... imiona i nazwisko rodzicw, nr kontaktowy II. Informacje o dziecku/uczniu  prosz opisa 1. Indywidualne potrzeby rozwojowe i edukacyjne ....................................................................................................................................................... ....................................................................................................................................................... ................................................................................................................................................... 2. Mocne strony, predyspozycje, zainteresowania i uzdolnienia dziecka/ucznia ....................................................................................................................................................... ....................................................................................................................................................... ................................................................................................................................................... 3. Przypuszczalne przyczyny niepowodzeD edukacyjnych lub trudno[ci w funkcjonowaniu dziecka/ucznia w przedszkolu/szkole/placwce ....................................................................................................................................................... ....................................................................................................................................................... ................................................................................................................................................... 4. DziaBania podjte przez nauczycieli/wychowawcw grup wychowawczych i specjalistw w celu poprawy funkcjonowania dziecka/ucznia ....................................................................................................................................................... ....................................................................................................................................................... ................................................................................................................................................... ................................................................................................................................................... ................................................................................................................................................... 5. Efekty podjtych dziaBaD i udzielonej pomocy & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & ... ............................................. * R 2 T X \ 7j`b8R$,;L<Uhe hkwh{+hkwh{+CJ hkwCJh{+CJaJ h{+CJ hkw6] h{+6]h{+CJaJh{+, . R V Z \   o89:bd"$a$'&$a$$xa$TVCDrsYZI  $a$ J!K!!!"""P#R###,,.../0/2///1 1J2L2v3x3$a$.......................................................................................................... & ................................................................................................................................................... & ................................................................................................................................................... 6. Wnioski dotyczce dalszych dziaBaD majcych na celu popraw funkcjonowania dziecka/ucznia ....................................................................................................................................................... & ................................................................................................................................................... & ................................................................................................................................................... & ................................................................................................................................................... & ................................................................................................................................................... 7. Inne uwagi dotyczce dziecka/ucznia i jego [rodowiska rodzinnego: ....................................................................................................................................................... ....................................................................................................................................................... ....................................................................................................................................................... ....................................... podpis dyrektora x344555\6^67788999:D<H<J<L<$a$$a$,1h. 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