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?)