Servicio de Apoyo Itinerante en Problemas Emocionales y de ConductaCircuito 08Docente: Cinthia Hidalgo Salas Entrevista a padresPeriodo !0"#A. Datos Personales$ombre del Estudiante:%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%&echa de nacimiento:%%%%%%%%%%%%%%%$'mero de C(dula:%%%%%%%%%%%%%%)el(*ono:%%%%%%%%%%% Celular:%%%%%%%%%%%%% )el del traba+o:%%%%%%%%%%%%%%%En caso de emergencia:%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%Edad:%%%%%%%%%%%%A,o -ue cursa:%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%$ombre del docente:%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%Direcci.n e/acta:%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%B. Ncleo Familiar$ombre del padre:%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%Edad:%%%%%%% $acionalidad:%%%%%%%%%%%%%%%%%%% 0cupaci.n:%%%%%%%%%%%%%%%C(dula de Identidad:%%%%%%%%%%%%%% Estudios 1eali2ados:%%%%%%%%%%%%%%%%%%3ugar de traba+o:%%%%%%%%%%%%%%%%%%%%%%%Horario:%%%%%%%%%%%%%%%%%%%%%%%%%%$ombre de la madre:%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%Edad:%%%%%%% $acionalidad:%%%%%%%%%%%%%%%%%%% 0cupaci.n:%%%%%%%%%%%%%%%C(dula de Identidad:%%%%%%%%%%%%%% Estudios 1eali2ados:%%%%%%%%%%%%%%%%%%3ugar de traba+o:%%%%%%%%%%%%%%%%%%%%%%%Horario:%%%%%%%%%%%%%%%%%%%%%%%%%%Estado conyugal de los padres: 45 Solteros 45 Casados45 6ni.n 3ibre45 Separados 45 Divorciados 457iudo 4a5El estudiante convive con: El padre %%%%%%% 3a madre%%%%%%%%Hermanos%%%%%%%% Padrastro:%%%%%%%%%8adrastra%%%%%%%% 0tros:%%%%%%%%%8iembros de la *amilia -ue viven en lacasa$ombre completo Se/o EdadParentesco0cupaci.n9C.mo considera usted las relaciones *amiliares en su hogar:E/celentes%%%%%%%%%%;uenas%%%%%%%%%%% 1egular%%%%%%%%% 8alas%%%%%%%Indi-ue las principales situaciones Problem