SECRETARIA DE ESTADO DA EDUCAO

GERNCIA DE PROJETOS ESPECIAIS

PROGRAMA DE TECNOLOGIA EDUCACIONAL
NUCLEO DE TECNOLOGIA EDUCACIONAL

FORMULRIO DE DIAGNSTICO DO LIE e TVE

1.DADOS/ESCOLA:
INEP:______________________________________________________________________________________________
a) ESCOLA:_________________________________________________________________________________________
b) ENDEREO:______________________________________________________________________________________
c) TELEFONE:______________________ EMAIL:__________________________________________________________
d) MUNICIPIO/DISTRITO:_____________________________________________________________________________
e) SITE/BLOG:_______________________________________________________________________________________
f) MODALIDADE DE ENSINO: REGULAR: ( ) FUNDAMENTAL ( ) MDIO
EJA: ( ) FUNDAMENTAL ( ) MDIO ( ) OUTROS____________________________________________________
g) N DE ALUNOS:__________N DE DOCENTES:___________ N DE SALAS:________________________________
h) N DE TURMAS: MANH ____________ TARDE ___________ NOITE:___________________________________
i) N DE LIE:_______________________
j) N DE TELESSALA: _________________________________________
2. GESTORES:
DIREO:_________________________________________________________________________________________
TELEFONE:________________________SITE/BLOG:______________________________________________________
EMAIL:_____________________________________________________________________________________________
INICIO DE ATUAO:_______________________________________________________________________________
b) VICE-DIREO:_________________________________________________________________________________
TELEFONE:_________________________ SITE/BLOG:____________________________________________________
EMAIL:____________________________________________________________________________________________
INICIO DE ATUAO:_______________________________________________________________________________
3. COORDENADOR (A) DO LIE:
1.____________________________________________________________________________Turno:_________________
Email:_______________________________________Telefone:_________________ INICIO DE ATUAO:___________
Formao do coordenador:______________________________________________________________ _______________
2.____________________________________________________________________________Turno:_________________
Email:_______________________________________Telefone:_________________ INICIO DE ATUAO:___________
Formao do coordenador:______________________________________________________________________________
3._____________________________________________________________________________Turno:________________
Email:_______________________________________Telefone:_________________INICIO DE ATUAO:___________
Formao do coordenador:______________________________________________________________________________
4. COORDENADOR (A) DA TELESSALA:
1._____________________________________________________________________________ Turno:________________
Email:_____________________________________ Telefone:_________________ INICIO DE ATUAO:____________
Formao do coordenador:______________________________________________________________________________
2._____________________________________________________________________________ Turno:________________
Email:_________________ ____________________Telefone:_________________ INICIO DE ATUAO:____________
Formao do coordenador:______________________________________________________________________________
3._____________________________________________________________________________ Turno:________________
Email:______________________________________ Telefone:_________________ INICIO DE ATUAO:___________
Formao do coordenador:______________________________________________________________________________
5. PROGRAMA:
a.( ) Proinfo
b.( ) Oi Tonomundo
c.( ) Alvorada
d.( ) Despertar
e.( ) Promed
f. ( ) Proinesp

g. ( ) Outro __________________________________________________________________________________
6. ESTRUTURA FSICA:
6.1 Sala do LIE (m2):_______________________________________________________________________________
a.Ar Condicionado (btus):______________________________Central de Ar (btus):_________________________
b.Rede Eltrica: ( )
Rede Lgica: ( )
c.Condies fsicas do ambiente:_____________________________________________________________________
Obs:________________________________________________________________________________________________
6.2Tamanho da Telessala(m2):_______________________________________________________________________
a) Ar Condicionado (btus):_____________________________Central de Ar (btus):_________________________
b) Quantidade de cadeiras no espao fsico: _________________________________________________________
c)Condies fsicas do ambiente:_________________________________________________________________
Obs:_______________________________________________________________________________________
7. MOBILIRIO/QUANTIDADE
( ) Computador
( ) Armrio com portas
( ) Cadeira
( ) Bancada
( ) Mesa
( ) Impressora
( ) Mquina fotogrfica digital
( ) Filmadora digital
( ) Quadro interativo
( )TV Analgica
( ) Antena Analgica
( ) Receptor de parablica
( ) TV por assinatura
( ) Aparelho de som
( ) Caixas de som amplificada
( ) Equipamento de rdio com transmisso
( ) Notebook
( ) Nobreack
( ) Leitor de DVD
( ) Gravador de DVD
( ) Leitor de VHS
( ) Prateleiras fixa
obs:_____________________________________________________________________________________________
8. CONEXO DE INTERNET
a) Banda Larga ( ) Gesac ( ) Oi TonoMundo ( ) SEDUC ( ) Outros_________________________________
9. FORMAO PROINFO;
a. ( ) INTRODUO A EDUCAO DIGITAL (40 H)
b. ( ) TECNOLOGIAS NA EDUCAO: ENSINANDO E APRENDENDO COM AS TIC (100H)
c. ( ) PROJETOS, CURRICULOS E TECNOLOGIA (40 H).
d. ( ) ALUNO INTEGRADO
OBS.:___________________________________________________________________________________________
Data:______/_______________/______________.
________________________________
Coordenador (a) - LIE
__________________________________
Formador (a)/ NTE/PVH

_______________________________
Coordenador (a) de Telessala
_______________________________
Coordenador (a) do NTE/PVH

____________________________________
Direo/Coordenao