República Bolivariana de Venezuela
U.E. Colegio Santa Mariana de Jesús
Inscrito en el
MPPE en el año 1950-1951
Cod. Plantel: S0399D2015 Cod. AVEC: 230028 RIF: J-31070540-2
Convenio MPPE-AVEC
SERVICIO DE ORIENTACION EDUCATIVA
Entrevista a Estudiantes
Nombres:
___________________________________Apellidos:_________________________
Grado/Año:__________ Edad: ______Sexo ____ Fecha de la Entrevista___________________
Dirección :
____________________________________________________________________ Teléfonos:________________________email_______________________Representante
Legal ________________________________________Padre( ) Madre(
) otro( )________________
Personas con quien vive______________________________________________ Docente
Guia o Maestra(o)__________________________Remitido por
_____________________________
MOTIVO DE LA ENTREVISTA:
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
EXPOSICION DEL ESTUDIANTE:
_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
ACUERDOS: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
FIRMA DEL ESTUDIANTE DOCENTE ORIENTADOR
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