Section 1 of 1
FORMATO DE APLICACIÓN
Qué opción te describe mejor?
Qué opción te describe mejor?
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1.
Estudiante
2.
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REGISTRO DEL CURSO
REGISTRO DEL CURSO
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Localización del Programa
Localización del Programa
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1.
Ecuador
2.
Galápagos
3.
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Selección del curso
Selección del curso
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INFORMACIÓN DEL ESTUDIANTE
INFORMACIÓN DEL ESTUDIANTE
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Nombre
Nombre
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Apellidos
Apellidos
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Cédula de identidad
Cédula de identidad
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Dirección (Calle y Número)
Dirección (Calle y Número)
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ex: 275 18 de febrero y Marchena
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Ciudad
Ciudad
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Estado/Provincia
Estado/Provincia
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Código Postal
Código Postal
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País
País
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Correo electrónico
Correo electrónico
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Escuela/Colegio/Preparatoria
Escuela/Colegio/Preparatoria
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Teléfono de Casa
Teléfono de Casa
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Número de Celular
Número de Celular
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Fecha de nacimiento
Fecha de nacimiento
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Género
Género
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1.
Femenino
2.
Masculino
3.
Prefiero no decirlo
4.
Otros
5.
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Peso (Kg)
Peso (Kg)
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Altura (cm)
Altura (cm)
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Cómo supiste sobre ECOS?
Cómo supiste sobre ECOS?
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Usted o alguien de su familia a participado en un curso de ECOS antes?
Usted o alguien de su familia a participado en un curso de ECOS antes?
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Sí
No
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PADRE / TUTOR DE INFORMACIÓN
PADRE / TUTOR DE INFORMACIÓN
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Tiene la misma dirección que el estudiante?
Tiene la misma dirección que el estudiante?
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Sí
No
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Nombre
Nombre
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Apellidos
Apellidos
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Cual es su relación con el estudiante?
Cual es su relación con el estudiante?
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1.
Padre
2.
Madre
3.
Padrastro
4.
Madrastra
5.
Representante legal
6.
Otro
7.
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Dirección (Calle y Número)
Dirección (Calle y Número)
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Ciudad
Ciudad
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Estado/Provincia
Estado/Provincia
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Código Postal
Código Postal
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País
País
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Teléfono de Casa
Teléfono de Casa
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Date
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Number
Text
Length
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Between
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Número de Celular
Número de Celular
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INFORMACIÓN DEL PARTICIPANTE
INFORMACIÓN DEL PARTICIPANTE
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Por favor, cuéntanos un poco sobre ti y por qué estás entusiasmado (a) de participar en un curso de ECOS
Por favor, cuéntanos un poco sobre ti y por qué estás entusiasmado (a) de participar en un curso de ECOS
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Tienes alergias alimenticias?
Tienes alergias alimenticias?
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Sí
No
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Tienes alguna restricción alimenticia?
Tienes alguna restricción alimenticia?
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Sí
No
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Restricciones alimentarias
Restricciones alimentarias
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1.
Ninguna
2.
Vegetariano
3.
Vegano
4.
Kosher
5.
Libre de gluten
6.
Pesquetariano
7.
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Talla de Camiseta/Playera
Talla de Camiseta/Playera
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1.
XS
2.
S
3.
M
4.
L
5.
XL
6.
XXL
7.
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