FORMULARIO UNICO DE POSTULACION Y RENOVACION
ANO 2015 - 2016 INFORME SOCIAL
BECAS DE MANTENCION Y BENEFICIO RESIDENCIA INDIGENA,
SECCION 1
ANTECEDENTES GENERALES. IseMesTRE [7] 1SEMESTRE [] POSTULANTE [—] RENOVANTE [7]
BECA A LA QUE POSTULA 0 RENUEVA,
BECA PRESIDENTE DE LA 'BENEFICIO RESIDENCIA
REPUBLICA, INDIGENA 'BECA MAGALLANES
BECA INDIGENA 'BECA LEY N° 19.125 (Ret) BECA AYSEN
BECA DE INTEGRACION 'BECA DECRETON® 1086 a
TERRITORIAL (enovante) eae
BECA CHAITEN (Renovante) 'BECA DUPLO (Renovante)
ESTADO EXCEPCION DEL RENOVANTE,
CCONTINUIDAD DE.
CARRERAS TECNICAS 0 APELACION macnn | |pes nats
PROGRAMAS INICIALES A —
(CARRERA PROFESIONAL ‘CAMBIO DE IES Dia [Mex | Ato Dia [Mes] Ato
(CAMBIO DE CARRERA, TITULACION SUSPENSION | | Desde Hasta
Dia [Mex | Ato Dia | Mes] Ato
ANTECEDENTES DEL POSTULANTE © RENOVANTE
"APELLIDO PATERNO ‘APELLIDO MATERNO PRIMER NOMBRE SEGUNDO NOMBRE
RUT: FECHA DE NACIMIENTO SEXO HOMBRE MUJER
EMAIL ESTADO CIVIL POSEE CUENTA RUT sr NO
‘Tat esadianie no posee cuenta RUT os nocoario stair que debe hablar una cosa Rul
Siclesudante no posee core personal debe crear un mail deconiacto personal
DOMICILIO FAMILIAR
‘CALLE N_ DPTO. POBLACION ‘COMUNA REGION FONOWELULAR
DOMICILIO DURANTE El. PERIODO DE ESTUDIOS
CALLE © PTO, POBLACION ‘COMUNA REGION FONOICELULAR
"UEBLO ORIGINARIO AL QUE PERTENECE (campo obligatorio postulacin y renovacin BLy BRI
‘Mapuche ‘Rapa Nui Dinar
‘Ayman “iacameto Sin ei
Yanan Coe
Kawhankar ‘Goecta,
POSEE ASCENDENCIA INDIGENA. Medio de veriicacién (marear con una x):
(CERTIFICADO CoNADI_ | TN: [LAPELLIDO INDIGENA DIRECTO —[ [EN TRAMITE, ieee
POSTULA Al BENEFICIO RESIDENCIA INDIGENA
Si
NO- "Nota: para aquollos estudiantes de educaién superior qu desean posta sl Benefcio Residencia Indiana esl
Henando todos sus campos. Pstulacn eicunserita yc Valid solamente alas regione de Arica y Purinacoia~ Tarapara~ Antoagaxa ~ Bio Bio Arnica
{Los Lagos ~ Las Rios ~ Magallanes.
piscaractpan, EMBARAZO ADOLESCENT
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