Fecha _______/________/________

ÁREA CONVIVENCIA ESCOLAR E INSPECTORÍA

REGISTRO DE ENTREVISTA ESTUDIANTE

IDENTIFICACIÓN
Estudiante : Curso :________Firma:____________________
Estudiante : Curso :________Firma:____________________
Estudiante : Curso :________Firma:____________________
Estudiante : Curso :________Firma:____________________
Estudiante : Curso :_______Firma:_____________________
Estudiante : Curso :_______Firma:____________________

Profesionales que entrevistan

Convivencia Escolar_____ Coordinadora_____ Inspectora_____ UTP_____ Director _____
Profesor(a) Jefe ____ Otro____________________________________

MOTIVO DE LA ENTREVISTA
Pupilo victima acoso escolar ____ Pupilo victimario acoso escolar_____ Acoso escolar cruzado______
Problemas académicos _____ Conflicto con docente___ Inasistencias reiteradas____
Otro __ Indicar ______________________________________________________________

FALTA DEL REGLAMENTO INTERNO

Leve ____ Grave ____ Gravísima ____

DESARROLLO DE LA ENTREVISTA:
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ACUERDO Y/O COMPROMISO :

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CONVIVENCIA ESCOLAR INSPECTORÍA GENERAL INSPECTORA