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SIMPADE Student Registration Form 2019

This document is a form for students that collects personal, family, housing, and academic history information. It requests information such as the student's name, age, and grade, housing characteristics, available services, academic history and performance, as well as socioeconomic and educational information about the student's guardian. The purpose is to identify risk factors and needs to design support strategies for the student.

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5 views2 pages

SIMPADE Student Registration Form 2019

This document is a form for students that collects personal, family, housing, and academic history information. It requests information such as the student's name, age, and grade, housing characteristics, available services, academic history and performance, as well as socioeconomic and educational information about the student's guardian. The purpose is to identify risk factors and needs to design support strategies for the student.

Translated by

ScribdTranslations
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

SIMPADE STUDENTS FORM 2019

LA GAITANA SCHOOL IED LOCATION A del estudiante________________________________________________


Nombre
Fecha de Nacimiento________ Grado_____ Jornada______ Numero de documento del estudiante_________________
Note: The questions asked below refer to the students. The questions marked with
(*) are mandatory.
INDIVIDUAL INFORMATION
Does the student live alone? * Yes No
Adolescent Pregnancy? * (Question Directed at Students) Yes No
Do you do any type of paid or unpaid work? * (Question directed at students) Yes No
Early motherhood or fatherhood? * (Question directed at students) Yes No
It states that he/she has been a victim of discrimination, physical assaults, or verbal assaults due to his/her expressions of
gender, sexual orientation or sexual identity? (For the LGTBI population) Yes No
Does it refer to having been a victim of physical, verbal, or sexual aggression by someone from their educational environment or
familiar? Yes No
It states that they have been a victim of discrimination based on: (You can check more than one option)
Disability
At their own learning pace
Physical appearance
Religion
To their ethnic belonging
Family characteristics
Others If I mark Others explain_________________________________________________________
FAMILY INFORMATION
Number of people living in the household *(Answer in number)
HOUSING CHARACTERISTICS
The type of housing is * (Select one option) House
Apartment
Fourth
Others (Tents, Hostels, etc.)
The ownership of the house is: *(Select one option) Own
Own with credit
Rental
Usufruct
Basic housing services: (Mark only one option) Renewable alternative energy
Water
Sewage system
Residential Gas
Phone
Internet
Energy
Garbage collection
SCHOOL TRAJECTORY
Did you have preschool education? * Yes No
Years in Preschool Education* (Respond in number)
¿Alguna vez se ha retirado del establecimiento educativo sin terminar el año escolar? * Si No
How long, in months, were you out of the educational system? * (Answer in number)
It is answered if in the previous question I marked Yes
Temporary abandonments (Current academic year) * (Respond with a number)
Have you repeated years? Yes
No
Number of times you have repeated years * (Respond in number)
Are you repeating the current grade? Yes No
Disciplinary background of academic life Average attendance from the previous year*
(Select only one option) (Marque una sola opción)
Calls for attention High (80% or more)
Suspensions Average (between 50% and less than 80%)
Warnings and suspensions Decrease (less than 50%)
Not applicable Not applicable
Does he/she have alterations in development or learning difficulties diagnosed by a specialist? * Yes No
Were you linked to an early education modality before entering Preschool? Yes No
Which subject or subjects are you not passing in period 1?
Natural sciences and environmental education
Social sciences, history, geography, political constitution and democracy
Art education
Ethical education and in human values
Physical education, recreation, and sports
Religious education
Humanities, Spanish language and foreign languages
Mathematics
Technology and computer science
STRATEGIES THAT THE STUDENT SHOULD HAVE
Subsidies conditional on school attendance
Complementary school day
School supplies
School uniform
School Transport
School feeding
Comprehensive care
FAMILY INFORMATION (This information refers to the father or guardian)
Name of the guardian_________________________________________________
Nivel educativo (marque una sola opción) Attend the report delivery (mark only one option)
Without education Always
Incomplete primary education Almost always
Completed primary education Sometimes
Incomplete media Almost never
Complete media Never
Incomplete upper
Superior complete
Postgraduate Tipo de empleo (marque una sola opción)
Attend meetings other than the delivery of newsletters Temporal
Always (mark only one option) Permanent
Almost always It doesn't have

Sometimes Frequency with which he has changed residence


Almost never last year (please select one option)
Never It hasn't changed
Between 1 and 2 times
Between 3 and 4 times
More than 4 times
SIGNATURE OF THE ATTENDANT______________________________________
The individuals involved in the handling of personal data during the process
NAME OF THE GUARDIAN ____________________________________ management of the coverage are required to ensure the reservation of information in
compliance with the provisions of Law 1581 of 2012 and National Decree 1377 of
GUARDIAN DOCUMENT NUMBER_________________________ 2013. The information requested in this form is included due to
technical and regulatory considerations provided by the Ministry of National Education

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