ENTREVISTA
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Nombres____________________ Apellidos________________ C.I____________ Edad_________ Grado________ Sección_______ Fecha____________ Hora______
Remitido por________________
Motivo de la Entrevista__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Diagnostico_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Recomendaciones________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Acuerdos_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Docente_________________ Entrvistado_______________
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