ENTREVISTA PARA ADOLESCENTES

Fecha: _____/_____________/______.
I.

DATOS PERSONALES:
Nombres y Apellidos:
Sexo:
Edad:

Fecha y lugar de Nacimiento:

Nivel de Instruccin:

Estado Civil:

Institucin:

Lugar de Aplicacin:

II.
ASPECTO-FSICO Y APARIENCIA PERSONAL:
Referencias antropomtricas:
Rasgos Fsicos:
Talla:
Peso:
Apariencia Personal:
Actitud Personal durante la Entrevista:
Observaciones:

III.
REA FAMILIAR
1. Conformacin del Grupo familiar:
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Tipo de familia: Nuclear Simple ( ) Extensa ( ) Monoparental ( ) Homoparental ( ) Ensamblada ( )

2. Ocupacin de los Integrantes del grupo familiar:

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3. Breve descripcin de la dinmica familiar:
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4. Condiciones Socioeconmicas:

Trabajan: Padre y Madre ( ) Madre ( ) Padre ( ) Adolescente ( ) Otros ( )

Vivienda: Ubicacin: urbano ( ) barrio ( )
Tipo de vivienda: edificio ( ) casa ( ) refugio ( ) rancho ( ) Otras ( )
Estado de la vivienda: Buena ( ) Regular ( ) Satisfactoria ( ) Mala ( )
Acceso al desarrollo tecnolgico: Telfono: mvil ( ) fijo ( ) TV ( ) Video ( )Computador ( )
Internet ( ) otros ( )
5. Observaciones:

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GENOGRAMA

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IV.

REA ACADMICA:

1. Estudia: Si ( ) No ( ) Por qu?________________________________________________

2. Nivel de instruccin actual:______________________________________________________
3. Institucin:__________________________________________________________________
4. Rendimiento acadmico:
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5. Asignaturas favoritas:
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6. Asignaturas en las que presenta mayor rendimiento acadmico:
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1. Asignaturas en las que presenta menor rendimiento acadmico:
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2. Qu carrera universitaria le gustara estudiar?
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3. Cmo se proyecta en el futuro?
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4. Observaciones:
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V.

REA SOCIAL:
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1. Estudia: Si ( ) No ( ) Por qu?________________________________________________

Descripcin:_______________________________________________________________________
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2. Qu concepto tiene sobre la amistad?
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3. Cmo lo perciben sus amistades?
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4. Cmo son las relaciones interpersonales con sus amistades?
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5. Cmo son las relaciones interpersonales dentro de la comunidad?
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6. Participa en actividades extraescolares? Si ( ) No ( ).
Deportiva ( ) Musical ( ) Artstica ( ) Intelectual ( ) Otro ( )
Descripcin:_______________________________________________________________________
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7. Lugares de esparcimiento dentro de la comunidad?
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8. Actividades Recreativas y de entretenimiento: (Tiempo de dedicacin)
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9. Programas de TV favoritos:
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10. Descanso y sueo:
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11. Presenta algn tema de inters en especial? Si ( ) No ( )
Poltica ( ) Economa ( ) Deporte ( ) Farndula ( ) Religin ( ) Otro ( )

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Explique:
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12. Demuestra preocupacin por algn drama social? Si ( ) No ( )
Explique:
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13. Demuestra inters por las redes sociales? Si ( ) No ( )
Frecuencia: Siempre ( ) Casi siempre ( ) A menudo ( ) Pocas veces ( ) Nunca ( )

Cules?
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14. Es adepto a alguna religin? Si ( ) No ( )
Cul?___________________________________________________________________________
Frecuencia: Siempre ( ) Casi siempre ( ) A menudo ( ) Pocas veces ( ) Nunca ( )

15. Demuestra inters por alguna cultura urbana? Si ( ) No ( )

Cules?_________________________________________________________________________
Nivel de Participacion:______________________________________________________________
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16. Cul es su opinin en relacin al consumo de sustancias licitas e ilcitas?
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1.
Observaciones:
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VI.

REA LABORAL:

1. Trabaja actualmente: Si ( ) No ( )
Diario ( ) Fines de Semana ( ) A destajo ( ) Por Horas ( ) Tiempo completo ( ) Fijo ( ) Por contrato ( ) Otro ( )

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2. Actividades desempeadas?
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3. Observaciones:
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VII.
REA FSICA:
1. Ha experimentado los cambios fsicos de la pubertad? Si ( ) No ( )
2. Cules?
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3. Cmo se siente con la aparicin de los cambios fsicos?
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4. Presenta alguna enfermedad? Si ( ) No ( )
Descripcin:
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5. Cmo describira su alimentacin?
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1. Observaciones:
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VIII.

REA SEXUAL:

1. Ha recibido informacin sobre el manejo de la sexualidad? Si ( ) No ( )

2. Qu informacin maneja en relacin a la sexualidad?
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3. De quien recibi la informacin?
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________________________________________________________________________________
4. Tiene conocimiento de la existencia de los mtodos anticonceptivos? Si ( ) No ( )
Explicar:
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5. Tiene conocimiento de la existencia de las ETS? Si ( ) No ( )
Explicar:
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6. Expresa curiosidad por algn tema en particular relacionado con la sexualidad? Si ( )No ( )
Explicar:
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7. Cul es la definicin que tiene de si mismo?
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8. Qu es lo que ms le agrada de s mismo?
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9. Qu es lo que no le agrada de s mismo?
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10. Observaciones:
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IX.

CONCLUSIN GENERAL:
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Entrevistador:__________________________________

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