REPÙBLICA BOLIVARIANA DE VENEZUELA
MINISTERIO DEL PODER POPULAR PARA LA EDUCACIÒN
ZONA EDUCATIVA DEL ESTADO COJEDES
AULA INTEGRADA
REFERENCIA DEL DOCENTE
Nombres y Apellidos_________________________________________________
Fecha De Nac.______________Edad_______________Sexo________________
Grado_______________ Secciòn ________________ Turno _____________
Nombre Y Apellidos
Del Representante.__________________________________________________
C.Inº-__________________ Direcciòn__________________________________
Telefonos_______________ Profesion__________________________________
MOTIVO DE REFERENCIA___________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
LECTURA_____________________________________________________________________________________________________________________________________________________________________________________________ESCRITURA___________________________________________________________________________________________________________________________________________________________________________________________CALCULO_____________________________________________________________________________________________________________________________________________________________________________________________COMPORTAMIENTO__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________OBSERVACIONES____________________________________________________________________________________________________________________________________________________________________________________________________________________________________
DOCENTE______________________________GRADO_______SECCIÓN_____
FIRMA_________________________
FECHA__________________________
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