1. MEMBERS _______________________ _______________________ ________________________ _________________________ _________________________ __________________________ GROUP _____________ TEACHERS ENGLISH: ________________________ INFORMATICA:___________________ MATHEMATICS: __________________ NATURAL SCIENCES: ______________ SPANISH: ________________________ TECNOLOGY:_____________________ INSTITUCIÓN EDUCATIVA TÉCNICO INDUSTRIAL SIMONA DUQUE MARINILLA 2009

2. PERSONAL INFORMATION NAME:________________ LAST NAME: ________________ ADDRESS___________________ PHONE: ___________ E-MAIL: ______________________ BIRTH DATE: __________________ CITY: _______ CARD IDENTY: ________________________ ACADEMIC INFORMATION PRIMARY SCHOOL: __________________ SEGUNDARY SCHOOL: _________________ FAMILY INFORMATION NAME YOUR FATHER: ___________________________ PROFESSION: _____________________ NAME YOUR MOTHER: ________________________ PROFESSION: _____________________ NUMBER OF BROTHERS: ______