Student Dropout Information Form
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ScribdTranslationsStudent Dropout Information Form
Translated by
ScribdTranslationsEDUCATIONAL INSTITUTION
TECHNICAL INSTITUTE
Santander de Quilichao, Cauca
DEAR PARENT
We kindly request you to complete
this form with truthful information, for
follow up on school dropout
through the SIMPADE Platform.
BASIC STUDENT INFORMATION
Nombres: Last names:
Tipo de Documento: R.C X C.C Identity Number:
Telephone: Genre: M X Date of birth:
Edad: Lugar de Residencia:
Residential Area: Rural Urban Victim of conflict? YES NO
Establishment where he/she studies
Nombre: Headquarters :
Degree or Cycle being pursued: Journey:
INDIVIDUAL INFORMATION
Does the student live alone? YES NO Adolescent Pregnancy? YES NO
Do you do any type of Paid or Unpaid Work? YES NO
Early Parenthood or Early Fatherhood? NO
Does it refer to having been a victim of discrimination, physical assaults, or verbal assaults due to their
YES NO
gender expressions, their sexual orientation or identity for the LGBTI population?
Do you state that you have been a victim of physical, verbal, or sexual aggression by your surroundings?
IF NO
educational or family?
He/She reports that he/she has been a victim of
Disability Your Learning Rhythm Physical appearance
Religion Your ethnic belonging Family characteristics
discrimination based on:
others? Which ones?
What do you want to study?
FAMILY INFORMATION
Number of people living in the household:
HOUSING CHARACTERISTICS
The type of housing is: House Apartment Rooms Others: Tents Hostels Another
The tenure of the housing is: Own Own with credit Rent Usufruct
Water Sewerage Gas Phone Internet Energy
Basic housing services:
Garbage collection Renewable Natural Energy
SCHOOL TRAJECTORY
Did you have preschool education? YES NO Years of Preschool Education:
Have you ever withdrawn from the educational institution without finishing the school year? YES NO
How many months were you out of the education system?
Temporary withdrawals (current school year) 1 2 3 4 Are you repeating the current grade? YES NO
Have you repeated any years? YES NO Number of times they have repeated years: 1 2 3 4 5 6
Disciplinary background attention calls Suspensions
of academic life: Warnings and suspensions Not applicable
Does he/she have extra-academic background (minor offender)? YES NO
Your average attendance from last year was: High: 80% or more Media: 50% Low: less than 50%
Does it show developmental alterations or learning difficulties diagnosed by a specialist? NO
Were you linked to an initial education modality before entering Preschool? YES NO
Which one or which ones Natural sciences and education Social sciences, history, geography, political constitution and
environmental democracy
EDUCATIONAL INSTITUTION
Technical Institute
Santander de Quilichao, Cauca
STRATEGIES THAT THE STUDENT SHOULD HAVE
Conditional subsidies for School Attendance Complementary School Day School Supplies
School Uniform School Transport School Nutrition
INFORMACION FAMILIAR
Names and surnames of the GUARDIAN:
Level Without education Incomplete primary education Complete primary education Incomplete media
Educational Complete media Superior complete Incomplete superior Postgraduate
Attend meetings other than the delivery of bulletins: Siempre Casi siempre Algunas veces Casi nunca Nunca
Attend report delivery: Siempre Casi siempre Algunas veces Casi nunca Nunca
Tipo de empleo: Temporal Permanent It doesn't have
It hasn't changed Between 1 and 2 times
Frequency with which you have changed residence in the last year
Between 3 and 4 times More than 4 times
REASONS WHY THE STUDENT DROPPED OUT
Personal:
Work Father at an early age Student health Extra age Poor academic performance
Reading problems Problemas de escritura Oral problems Expulsion of student
Repeat Little desire for study Academic difficulties
The methodologies and pedagogical processes do not respond to their particularities.
There is no training on life planning. There is no socio-occupational training
He/she thinks that studying will be of no use to him/her.
Familiar:
Change of residence Unemployment of parents or guardians Death of the parents
Forced displacement Little importance given to education by parents or guardians
Institutional:
Overcrowding Infrastructure problems Aggressive treatment Discrimination
Establishment in an unsafe area Establishment in a remote area
Establishment in disaster zone Incomplete degree offer Incomplete Teaching Staff
Pedagogical practices Inadequate shifts for the time of
Insufficient psychosocial care
inadequate student
Educational costs Non-inclusive offer Conflicts among students
Conflict among teachers Conflict among executives Conflict between students and teachers
Conflict between students and management Conflict between teachers and management
Context:
Gang violence Prostitution Drug addiction Presence of armed groups
Insecurity Bullying School bullying (Bullying) Presence of mines
Recruitment risk Illicit crops Distance from home to the establishment
Other Reasons:
Which ones?