ancheta sociala
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ANCHETA SOCIALA
ANCHETA SOCIALA
Asistent social.Locul i dataScopul.Numrul de nregistrare a cererii: .......................................................I. Date de identificare beneficiar
Nume i prenume:...Tel...Data i locul naterii:..Vrsta..CNP: __/__/__/__/__/__/__/__/__/__/__/__/__/ C.IStare civil..Domiciliul legal: Domiciliul n fapt:...Studii:
( primare ( generale ( liceale ( post liceale ( profesionale ( superioare
Ocupaia actual / instituiaEtnia: Religia: .II. Date despre familia beneficiarului:
a) So (soie)
Nume i prenume:...Tel...Data i locul naterii:VrstaCNP: __/__/__/__/__/__/__/__/__/__/__/__/__/ C.I
Domiciliul legal:.Domiciliul n fapt:..Studii:
( primare ( generale ( liceale ( post liceale ( profesionale ( superioare
Ocupaia actual / instituiaEtnia:.. Religia:..
Alte date despre soi
.
b) Copii
Nr.Nume si prenumeVarstaOcupatiaInstitutia
III. Alte persoane care locuiesc mpreun cu beneficiarul:
1. ....................................................................................................................................................................
2. ....................................................................................................................................................................
3. ....................................................................................................................................................................
IV. Situaia material / financiar:
a) Locuinta:
casa apartament alte situatii
personala cu chirie locuinta sociala alte situatii
Nr. camere: Nr. persoane (adulti).../copii
Telefon Electricitate Ap curent nclzire baie buctrie
frigider aragaz televizor alte..
Alte.precizri
b) Venituri / cheltuieli
Venituri lunareCheltuieli lunare
Nr.SumaSursaSuma Pentru ce ?
1.
2.
3.
4.
5.
V. Condiii igienico-sanitare:
VII.. Starea de sntate_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________VII. Relaiile n familie i comunitate:
Relaii n familie
...
Relaiile n comunitate:
........................................................................................................................................................
Relatiile cu rudele si vecinii
........................................................................................................................................................
Relatiile cu institutiile......................
**BisericaVIII. Observaii si concluzii:
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IX. Nevoi identificate:
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------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------X. Recomandri______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Persoane prezente la ntocmirea anchetei sociale:
1Asistent social
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