International Affairs Cultural Visit Program- F4 Student’s Profile (Please print) Student’s name: Birth date: Passport: Students need to leave and enter Chile on Chilean Passport. Home address: Phones: (family name) Day: Month: (names) Year: Age in March 2016: Chilean N° Expiration date: Other(describe) N° Expiration date: Street Number Neighbourhood Home: 56-32- Mobile: Father’s name: Family name names Home address: Street: Phones: Home: 56-32 City E-mail: Number Neighbourhood Mobile: City Office: E-mail: Occupation: Mother’s name: Family name Home address: Street: Phones: Home: 56-32 E-mail: Occupation: names Number Mobile: Neighbourhood City Office: International Affairs Cultural Visit Program- F4 Student lives with: Mother: Father: Both: In case of emergency call: Phones: Family name: Name: Relationship: Home: 56-32 Mobile: Office: E-mail Occupation: Date Pupil’s signature Parent’s name: Parent’s signature: Other: (whom?)