FICHA DE ENTREVISTA A ESTUDIANTE DERIVADO

• NOMBRES Y APELLIDOS DEL ESTUDIANTE:

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• EDAD: ______________ FECHA DE NACIMIENTO: __________________________

• GRADO Y SECCIÓN: ________________________________NIVEL: __________________________
• TIEMPO DE ESCOLARIDAD EN LA INSTITUCIÓN: _________________________________________
• TUTOR: _________________________________________________________________________
• FECHA: __________________________________________________________________________
MOTIVO DE CONSULTA:
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• OBSERVACIONES DURANTE ENTREVISTA

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• PROCESO DE EVALUACIÓN

FECHA TEST EVALUADO

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