IAESTE COLOMBIA

Universidad de Ibagué
Carrera 22 Calle 67 B/Ambalá
www.iaeste.org.co/

STUDENT NOMINATION REF. NO _____

IMPORTANT: Under no circumstances are you allowed to contact the company before
being accepted. You are accepted for this training offer only after receipt of the IAESTE
acceptance forms.

Personal information
Family name: Pulido nizo Date of birth: 04/03/1996

First and/or other names: jhon mario Place of birth: ubate-Cundinamarca

Home address: fuquene- vrda chinzaque Nationality: colombiana

Phone: (+57) 3102925755 Passport no:

Email: jhopulido@udca.edu.co Place of Issue: Bogotá DC

Address during terms:
Valid until:

Marital status: soltero

 Phone no: Sex: masculino

Alternative Email: mariopulido54@outlook.com Are you medically fit:

Study information

University/College: UDCA Knowledge of languages:

Faculty: medicina veterinaria

Specialization:

Completed years of study: 4 Total years required: 5

IMPORTANT: A list of subjects studied by the time training begins must be enclosed with this form as well as a
Curriculum Vitae (including details of previous work) and an introductory letter to the employer.

Desired period of training (within the period specified by the employer):

From: Agosto to: noviembre

Do you wish lodging to be found for you? Si

Are you required/do you wish to prepare a technical report during the training period? Si

Date: Student’s signature:

For official use only

Date: Nominating country: On behalf of sending country:

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