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特殊學(xué)生情況登記表范文第1篇

特殊學(xué)生情況登記表范文
為了更全面地了解學(xué)生的學(xué)習(xí)和生活狀態(tài)，學(xué)校需要在學(xué)生入學(xué)時(shí)進(jìn)行特殊情況登記。特殊學(xué)生情況登記表是一份關(guān)于學(xué)生身體、心理、家庭、學(xué)習(xí)等方面信息的統(tǒng)計(jì)表格，下面是一份范例，以供參考。
學(xué)生姓名：__________________________ 班級：_______________
家長姓名（或監(jiān)護(hù)人姓名）：____________________ 電話：__________________________
一、學(xué)生健康狀況
1. 是否有藥物過敏史：[ ]是 [ ]否，如有，請說明過敏藥物名稱：_____________________________
2. 是否有慢性病史：[ ]是 [ ]否，如有，請說明：_________________________________________
3. 是否有特殊膳食需求：[ ]是 [ ]否，如有，請說明：___________________________________
4. 是否曾有過手術(shù)史：[ ]是 [ ]否，如有，請說明手術(shù)類型：______________________________
二、學(xué)生心理健康狀況
1. 是否有心理問題或特殊需求：[ ]是 [ ]否，如有，請說明：______________________________
2. 是否有情緒問題或行為問題：[ ]是 [ ]否，如有，請說明：______________________________
3. 當(dāng)前是否在接受心理醫(yī)生的治療或咨詢：[ ]是 [ ]否，如是，請說明治療或咨詢原因和情況：_________________
三、學(xué)生家庭情況
1. 父親是否在家中：[ ]是 [ ]否
2. 母親是否在家中：[ ]是 [ ]否
3. 是否是獨(dú)生子女：[ ]是 [ ]否，如果否，請說明家中兄弟姐妹數(shù)量：__________________________
4. 父母職業(yè)：父親：______________，母親：______________，是否離異：[ ]是 [ ]否
5. 家庭成員是否有特殊身體或心理需求：[ ]是 [ ]否，如有，請說明：___________________________
四、學(xué)生學(xué)習(xí)情況
1. 是否有學(xué)習(xí)障礙：[ ]是 [ ]否，如有，請說明：_____________________________
2. 是否有學(xué)習(xí)優(yōu)勢：[ ]是 [ ]否，如有，請說明：_____________________________
3. 是否需要特殊輔導(dǎo)或支持：[ ]是 [ ]否，如是，請說明需要的輔導(dǎo)或支持類型：___________________________
4. 是否曾經(jīng)因?qū)W習(xí)問題受到校紀(jì)處分：[ ]是 [ ]否，如是，請說明情況：_____________________________
以上是特殊學(xué)生情況登記表范文，學(xué)校可根據(jù)學(xué)生具體情況進(jìn)行適當(dāng)調(diào)整。學(xué)校應(yīng)保護(hù)學(xué)生隱私，所有登記表格應(yīng)妥善保存，不得外泄。同時(shí)，根據(jù)學(xué)生登記表上的情況，學(xué)校應(yīng)加強(qiáng)對特殊學(xué)生的關(guān)注和支持，確保他們能夠平穩(wěn)學(xué)習(xí)和生活。

特殊學(xué)生情況登記表范文第2篇

特殊學(xué)生情況登記表范文
為了更好地解決學(xué)生在學(xué)習(xí)和生活中所遇到的各種問題，教育部門和學(xué)校對于特殊學(xué)生開展了相應(yīng)的特殊教育工作。而在這個(gè)過程中，一份完整的特殊學(xué)生情況登記表是必不可少的。接下來，本文將給大家介紹一份特殊學(xué)生情況登記表的范文，供大家參考。
【學(xué)生基本信息】
填寫日期：___________
學(xué)生姓名：______________
性別：______________
年齡：______________
家庭住址：______________
聯(lián)系電話：______________
所屬班級：______________
姓名：______________
【家庭背景】
1.家庭成員及家庭成員情況（父母、兄弟姐妹、祖父母等）：
___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2.父母的職業(yè)及工作情況：
_____________________________________________________________________________________________________________________________________________________________________________________________________________________
3.父母的教育程度及文化水平：
_____________________________________________________________________________________________________________________________________________________________________________________________________________________
4.家庭收入情況：
_____________________________________________________________________________________________________________________________________________________________________________________________________________________
5.家庭成員的健康狀況：
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
【學(xué)生自身情況】
1.既往病史及重大事項(xiàng)（如手術(shù)、治療等）：
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2.身體殘疾情況：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3.精神殘疾情況：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4.學(xué)習(xí)特長（如音樂、舞蹈、繪畫等）：
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
5.特殊才能（如體育、科技創(chuàng)新等）：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
6.學(xué)習(xí)能力（如閱讀、寫作、口語等）：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
7.息息相關(guān)的情感和行為問題：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
【教育背景】
1.學(xué)校教育經(jīng)歷（包括幼兒園到高中的學(xué)習(xí)情況）：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2.曾獲得榮譽(yù)的情況（如數(shù)學(xué)競賽獲獎(jiǎng)、籃球比賽進(jìn)球王等）：
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3.教育機(jī)構(gòu)或師資來自特殊學(xué)?；驇煼叮?br>____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4.托管或社區(qū)課程（如小學(xué)課外班或語言學(xué)習(xí)機(jī)構(gòu)）：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
【評估信息】
1.學(xué)生特別關(guān)注的領(lǐng)域：
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2.和學(xué)生合作過的教育工作者的反饋：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3.學(xué)生在校表現(xiàn)的領(lǐng)域（學(xué)業(yè)成績、社交等）：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
4.學(xué)生需求和支持類型（如口語治療、職業(yè)指導(dǎo)、學(xué)習(xí)支持等）：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
5.相關(guān)問題的監(jiān)控建議：
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
【附加信息】
1.學(xué)生愛好：
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2.學(xué)生在校其他社交經(jīng)歷（如學(xué)生會、文藝社等）：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
3.其他需要了解的信息：
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
以上是一份特殊學(xué)生情況登記表的范本，對于有特殊教育需求的學(xué)生和家長而言，這份表格將有助于學(xué)校和家庭更好地保障特殊學(xué)生的學(xué)習(xí)和生活。同時(shí)，在這份表格中，還可以根據(jù)具體情況進(jìn)行適當(dāng)修改，以滿足不同學(xué)校和學(xué)生的需求。綜上所述，建立一份完整的特殊學(xué)生情況登記表，對于推進(jìn)特殊教育工作，借助產(chǎn)生積極的作用。

特殊學(xué)生情況登記表范文第3篇

特殊學(xué)生情況登記表范文
為了更好地服務(wù)特殊學(xué)生，我們學(xué)校決定采用特殊學(xué)生情況登記表，以便更全面地了解特殊學(xué)生的身體狀況以及心理狀況，為他們提供更專業(yè)的教育服務(wù)。以下是特殊學(xué)生情況登記表的范文。
1.基本信息
①姓名：
②性別：
③出生日期：
④家庭住址：
⑤電話：
2.病史
①有無過敏史：
②有無遺傳病史：
③有無慢性病史：
④有無手術(shù)史：
⑤有無其他病史：
3.身體健康
①身高：
②體重：
③視力：
④聽力：
⑤口腔健康狀況：
⑥運(yùn)動能力：
⑦飲食偏好：
⑧睡眠質(zhì)量：
4.心理健康
①是否有精神障礙：
②是否有注意力缺陷障礙：
③是否有情感障礙：
④是否有學(xué)習(xí)障礙：
⑤能否自理：
5.家庭情況
①家庭成員：
②家庭經(jīng)濟(jì)狀況：
③父母從事的職業(yè)：
④家庭氛圍：

特殊學(xué)生情況登記表記錄的是學(xué)生的基本信息以及身體與心理情況，為學(xué)校提供更好的服務(wù)支持，更好的開展教育工作。我們期望通過這個(gè)登記表，更好地關(guān)心特殊學(xué)生并提供專業(yè)化服務(wù)。同時(shí)，學(xué)校也希望家長能夠認(rèn)真填寫該表格，以便更好地為學(xué)生服務(wù)。

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