Escolar Documentos
Profissional Documentos
Cultura Documentos
N de Exp.
FECHA: _________________________________
Apellido paterno
Apellido materno
Nombres
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Edad
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Estado civil
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Especialidad
Cdigo
Domicilio:______________________________________________________________________
Vives con:
Padres
Familiares
Amistades
Pensin
Telf.______________
Otros _________________
DATOS DE LA MADRE
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Nombre completo
Vive: S edad:_____ No ao de fallecimiento:_____
Instruccin:
Instruccin:
Primaria
Secundaria
Superior Tcnica incompleta
Superior Tcnica completa
Superior Universitaria incompleta
Superior Universitaria completa
Ocupacin: ____________________________________
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Nombre completo
Primaria
Secundaria
Superior Tcnica incompleta
Superior Tcnica completa
Superior Universitaria incompleta
Superior Universitaria completa
Ocupacin: ___________________________________
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Nmero de hermanos: ___________(sin incluirse el alumno) Nombre, edad y ocupacin de cada uno de ellos (de mayor a menor)
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2.
ESCOLARIDAD:
Ao en que terminaste la instruccin secundaria:
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3.
ASPECTOS ACADEMICOS:
Semestre de ingreso
Modalidad de Ingreso:
ITS Alumnos Destacados
Primera Opcin
Ceprepuc
Ingreso Adulto
Traslado Externo
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Universidad de procedencia
A
B
C
D
Clave:
En caso de opcin D:
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Qu cursos electivos y/o actividades has llevado o piensas llevar? Por qu?
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Qu opinas sobre tu desempeo como estudiante universitario?
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2.
ASPECTOS VOCACIONALES:
3
3. ASPECTOS LABORALES
Qu
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4. Qu esperas de la vida?
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5
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FIRMA