Estudiante

UNIVERSIDAD NACIONAL DE CHIMBORAZO
FACULTY of HEALTH SCIENCES
LANGUAGE CENTER
SOCIOECONOMICAL STUDENTS’ CARD Cód. 001
1. Last names First Name Middle name¿What’s your favorite name? |
2. Up to date Residence | 3. How long (years? | Conventional phone : …..………………….Cell:………………………. |
4. Nationality | 5. Cédula de Identidad| 6. Place of birth | 7. Birth date (dd –mm-yy) |
8. Email address | 9.Gender :M….. F…. | 10.Marital status : Single Married Divorced Separated EngagedCo-habitating Widow Others |
11. Languages (native language first ) | READING | WRITING | CONVERSATION |
| Excelente |Bien | Regular | Elemental | Excelente | Bien | Regular | Elemental | Excelente | Bien | Regular | Elemental |
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12. What do you prefer to learn? | English Spanish Quichua Others |
13.Knowledge about NTICs.Excellent Good Average Basic |
14.What NTICs programs do you use regurlarly? |
15. Education : University, high school, primary school. Startwith the highest level |
Year, semester | Major | Time | Institution | City- Province |
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16. Do you work? Yes No | Does this interfere with your studies ? Yes No |
What do you do exactly? | Explain the interference || |
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17. Graduated with honors: Graduated Suma Cum Laude, scholarships, Diplomas, Important Certificates. | | | | | |
Description | Institution | City–...