Paternal Surname

Maternal Surname

Names

Country of residence

Department of Residence

Province of Residence

District of Residence

Street and number

Phone

Date of birth

Country of birth

City of birth

District of Birth

Nationality

Language(s) spoken at home

Sex - None -MaleFemale

Student lives with

 

 

 

ID number

From (date)

Last day of attendance

Grade(s)

Name of the past college

Father present - None -YesNo

Father's last name(s)

Father's names

Father's Date of birth

Father's Country of birth

Department / State

Province / Region

District

Marital status - None -MarriedDivorcedSingleSeparatedWidowedConviviente

Studies

Country of residence

Department of Residence

Father's Province of Residence

Father's District of Residence

Home address

Father's Profession

Father's Employer

Office address

Fathe'rs Work Phone Numbers

Position

Type of ID - None -DNIRUCCarnet de Extranjería

ID Number

R.U.C.(only peruvian people)

Email

Home phone

Mobile phone

Alumnus? - None -YesNo

Mother present? - None -YesNo

Mother's lastname

Mother's Names

Mother's Date of birth

Mother's Country of birth

Mother's Department / State

Mother's Province / Region

Mothers District

Marital status - None -MarriedDivorcedSingleSeparatedWidowedConviviente

Studies

Country of residence

Mother's Department of residence

Mother's Province of residence

Mother's District of Residence

Mother's Address

Mother's Profession

Mother's Employer

Office address

Work phone

Mother's position

Type of ID - None -DNIRUCCarnet de Extranjería

ID number

R.U.C. (only peruvian people)

Mother's Email

Home phone

Mobile phone

Alumnus? - None -YesNo

Live separately? - None -YesNo

Who should bulletins be sent to? - None -Al PadreA la MadreAl Apoderado

Name of friend or relatives **In case they can't be reached

Phones In case of emergency

Doctor's name

Phone

Clinical center's name **It is clear that in case of accidents student will be taken to the closest medical center. Should be circunstances allow it, I would prefer my child be taken

Please give us any information about your child's health that may be necessary to our nurses office.

Legal guardian's last name(s)

Legal Guardian's names

Country of residence

Department of Residence

Province of residence

District of residence

Office address

Legal guardian's Profession

Legal Guardian's Employer

Office address

Work phone

Position

Type of ID - None -DNIRUCCarnet de Extranjería

ID number

R.U.C. (only peruvian people)

Phone

Mobile phone

Email

Alumnus? - None -YesNo

Name

Date of birth

Age

Sex - None -MaleFemale

School or University