Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Level 1 : Learning activity 3 : Stage 1 A1 Level 1 : Learning activity 3 : Stage 3

MOVING TO A NEW PLACE
Home earch application orm
Please write the frst or main applicants surname here
Important: Please make sure you read all the informaton presented in this document carefully before
you complete this form.
First name(s)
Give any other name(s)
you were previously known by
Date of birth
For example 06/12/1968
Current address
Postcode
Contact/correspondence
or safe address (if diferent
from above)
Contact telephone
numbers(s)

Email address
A. Your details
Cuasquen
Anguie
Maritza
23/11/1995
Carrera 5th number 12f-20, Pilar neighborhood
316 378 49 74
amcuasquen@misena.edu.co
Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.
A1 Level 1 : Learning activity 3 : Stage 1
Do you experience difcultes
with reading or writng?
Whats your gender?
What is your religion?
Yes
Yes
Male
Prefer not to say
Muslim Sikh
Buddhist
Christan
None
Hindu
Jewish
Other
(please specify)
No
No
Female
B. Employment information
C. Your family or household
If you are working, please tell us:
What do you do?
We need to know if other people will be moving with you. This will help us to know what type of home
you will need. Please give their details below.
1st 2nd 3rd
Last name
First name
Date of birth
Gender
Relatonship
to you (wife,
son, etc.)
x
x
x
x
I am a student
Mera Delgado
Elena Katherin
15/10/1972 01/01/2008
female Female
mother sister
Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.
A1 Level 1 : Learning activity 3 : Stage 1
D. Your present accommodation/circumstances
E. Your house preferences
Tick the box against the property type in which you live or best describes your circumstances.
State your house preferences describing all the characteristcs you want your new home to have.
House Trailer Hostal
Flat/apartment condominium Hotel
Bungalow Cotage Terraced house
Detached house Semi-detached house No fxed address
House type (apartment, cotage, etc.)
Number of rooms
Number of bathrooms
Which foor (if located in a building)
Public utlites (gas, water, etc.)
Locaton
Price
x
Detached house
4
2
Water, electricity, Internet and Cable TV
service
In Pasto city
$400.000
Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.
A1 Level 1 : Learning activity 3 : Stage 1
F. Special requirements
Write a more detailed descripton of the kind of house you want to have.
G. Applicants signature
Name
Date
i want a beautiful garden next to house, located in a quiet place.
Anguie Maritza Cuasquen Mera
1.085.325.128