History Taking Form
History Taking Form
31 Sher
her Shah Block, New Garden Town
(042) 99231366
sed.punjab.gov.pk/academics
SECTION-I
Family History
Consanguinity
SECTION II
Birth History
Developmental Milestones
SECTION III
SECTION IV
Educational History
Mention the previous school if attended (if any) ____________________________________
Age at the time of admission: ______________ class of admission: ____________________
Progress in school work (Poor/ Satisfactory/ Good) _____
_________________________________
___________________________
Grades repeated? if yes, why ? ________________ Reason of withdrawal
drawal __________________
________________
Performance Level
Comments
Average
Average
Average
Academic Area
Above
Below
i. English
Reading
ii. Urdu
i. English
Writing
ii. Urdu
Numerical Ability
Any additional support (coaching / Tuition / academy / remedial class)) provided or not:
not if yes
mention the hours: ____________
___________________ Classroom participation: Active / Passive
Attitude towards studies: _____________________
_____________________________________________________
____________________
Interests & Hobbies
Likes: Dislikes:
__________________________________ _______________________________________
__________________________________ _____________________________________
___________________________________
Leisure time activities: ________________________________________________________
______________________________
_________
Psychologist’s Name & Signatures:
Date: ______________