<table id="sheet0" class="sheet0 gridlines" style="width: 933px; border-color: #000000; height:

1871px;" border="10" cellspacing="0" cellpadding="0,5">

<tbody>

<tr class="row0" style="height: 25px;">

<td class="column0 style29 null style29" style="border-color: #000000; width: 395px; height:
48px;" colspan="6" rowspan="2">&nbsp;</td>

<td class="column6" style="border-color: #000000; background-color: #d5edea;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">FECHA DE MATRICULA</span></strong></td>

<td class="column8" style="border-color: #000000; background-color: #d5edea;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">N° DE
MATRICULA</span></strong></td>

</tr>

<tr class="row2" style="height: 23px;">

<td class="column6 style26 null style26" style="border-color: #000000; width: 158px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column8 style27 null style27" style="border-color: #000000; width: 119px; height:
23px;" colspan="2">&nbsp;</td>

</tr>

<tr class="row3" style="height: 25px;">

<td class="column0 style28 s style28" style="border-color: #000000; width: 672px; height: 25px;
background-color: #757171;" colspan="10"><span style="font-size: 14pt; font-family: helvetica,
arial, sans-serif;"><strong>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
&nbsp; &nbsp; &nbsp; &nbsp; <span style="color: #ffffff;">&nbsp; &nbsp; &nbsp; &nbsp;<span
style="font-size: 18pt;">FICHA DE MATRICULA</span></span></strong></span></td>

</tr>

<tr class="row4" style="height: 8px;">

<td class="column0 style16 s style16" style="border-color: #000000; width: 672px; height: 8px;"
colspan="10">&nbsp;</td>
</tr>

<tr class="row4" style="height: 34px;">

<td class="column0 style16 s style16" style="border-color: #000000; width: 672px; height: 34px;
background-color: #757171;" colspan="10"><span style="font-size: 12pt; font-family: helvetica,
arial, sans-serif; color: #ffffff;"><strong>I. IDENTIFICACIÓN DEL ESTABLECIMIENTO Y NIVEL DE
ENSEÑANZA</strong></span></td>

</tr>

<tr class="row5" style="height: 24px;">

<td class="column0 style17 s style17" style="border-color: #000000; background-color:

#d5edea;" colspan="4"><span style="font-family: helvetica, arial, sans-
serif;"><strong>IDENTIFICACIÓN DEL ESTABLECIMIENTO</strong></span></td>

<td class="column4 style17 s style17" style="border-color: #000000; background-color:

#d5edea;" colspan="3"><span style="font-family: helvetica, arial, sans-
serif;"><strong>NIVEL</strong></span></td>

<td class="column7 style18 s style20" style="border-color: #000000; background-color:

#d5edea;" colspan="3"><span style="font-family: helvetica, arial, sans-
serif;"><strong>CURSO</strong></span></td>

</tr>

<tr class="row6" style="height: 25px;">

<td class="column0 style21 s style21" style="border-color: #000000; width: 289px; height:

25px;" colspan="4"><span style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">LICEO
FRANCISCO BASCUÑÁN GUERRERO</span></td>

<td class="column4 style22 null style24" style="border-color: #000000; width: 185px; height:
25px;" colspan="3">&nbsp;</td>

<td class="column7 style22 null style24" style="border-color: #000000; width: 198px; height:
25px;" colspan="3">&nbsp;</td>

</tr>

<tr class="row7" style="height: 24px;">

<td class="column0 style16 s style16" style="border-color: #000000; width: 672px; height: 24px;
background-color: #757171;" colspan="10"><span style="font-family: helvetica, arial, sans-serif;
color: #ffffff;"><strong>II. IDENTIFICACIÓN DEL(A) ALUMNO(A)</strong></span></td>
</tr>

<tr class="row8" style="height: 25px;">

<td class="column0 style21 s style21" style="border-color: #000000; background-color:

#d5edea;" colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">APELLIDO PATERNO</span></strong></td>

<td class="column2 style21 s style21" style="border-color: #000000; background-color:

#d5edea;" colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">APELLIDO MATERNO</span></strong></td>

<td class="column4 style21 s style21" style="border-color: #000000; background-color:

#d5edea;" colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">NOMBRES</span></strong></td>

<td class="column7 style31 s style33" style="border-color: #000000; background-color:

#d5edea;" colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">SEXO</span></strong></td>

</tr>

<tr class="row9" style="height: 23px;">

<td class="column0 style27 null style27" style="border-color: #000000; width: 119px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column2 style27 null style27" style="border-color: #000000; width: 170px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column4 style27 null style27" style="border-color: #000000; width: 185px; height:
23px;" colspan="3">&nbsp;</td>

<td class="column7 style34 null style36" style="border-color: #000000; width: 198px; height:
23px;" colspan="3">&nbsp;</td>

</tr>

<tr class="row10" style="height: 26px;">

<td class="column0 style21 s style21" style="border-color: #000000; background-color:

#d5edea;" colspan="3"><span style="font-family: helvetica, arial, sans-serif; font-size:
10pt;"><strong>R.U.N.</strong></span></td>

<td class="column3 style21 s style21" style="border-color: #000000; background-color:

#d5edea;" colspan="2"><span style="font-family: helvetica, arial, sans-serif; font-size:
10pt;"><strong>AÑO ESCOLAR</strong></span></td>
<td class="column5 style21 s style21" style="border-color: #000000; background-color:
#d5edea;" colspan="3"><span style="font-family: helvetica, arial, sans-serif; font-size:
10pt;"><strong>EDAD AL 31 DE MARZO</strong></span></td>

<td class="column8 style21 s style21" style="border-color: #000000; background-color:

#d5edea;" colspan="2"><span style="font-family: helvetica, arial, sans-serif; font-size:
10pt;"><strong>TELEFONO ALUMNO</strong></span></td>

</tr>

<tr class="row11" style="height: 25px;">

<td class="column0 style30 null style30" style="border-color: #000000; width: 199px; height:
25px;" colspan="3">&nbsp;</td>

<td class="column3 style17 n style17" style="border-color: #000000; width: 144px; height:

25px;" colspan="2"><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">2018</span></td>

<td class="column5 style27 null style27" style="border-color: #000000; width: 210px; height:
25px;" colspan="3">&nbsp;</td>

<td class="column8 style30 null style30" style="border-color: #000000; width: 119px; height:
25px;" colspan="2">&nbsp;</td>

</tr>

<tr class="row12" style="height: 25px;">

<td class="column0 style21 s style21" style="border-color: #000000; background-color:

#d5edea;" colspan="3"><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;"><strong>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; FECHA DE
NACIMIENTO</strong></span></td>

<td class="column3 style42 s style47" style="border-color: #000000; background-color:

#d5edea;" colspan="5" rowspan="2"><span style="font-size: 10pt; font-family: helvetica, arial,
sans-serif;"><strong>DOMICILIO(CALLE, N°, POBLACIÓN,SECTOR,CIUDAD)</strong></span></td>

<td class="column8 style48 s style51" style="border-color: #000000; background-color:

#d5edea;" colspan="2" rowspan="2"><span style="font-size: 10pt; font-family: helvetica, arial,
sans-serif;"><strong>URBANO/RURAL</strong></span></td>

</tr>

<tr class="row13" style="height: 25px;">

<td class="column0 style2 s" style="border-color: #000000; background-color:

#d5edea;"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">DÍA</span></strong></td>

<td class="column1 style2 s" style="border-color: #000000; background-color:

#d5edea;"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">MES</span></strong></td>

<td class="column2 style2 s" style="border-color: #000000; background-color:

#d5edea;"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">AÑO</span></strong></td>

</tr>

<tr class="row14" style="height: 23px;">

<td class="column0 style52 null style24" style="border-color: #000000; width: 66px; height:
23px;">&nbsp;</td>

<td class="column0 style52 null style24" style="border-color: #000000; width: 53px; height:
23px;">&nbsp;</td>

<td class="column0 style52 null style24" style="border-color: #000000; width: 80px; height:
23px;">&nbsp;</td>

<td class="column3 style22 null style24" style="border-color: #000000; width: 354px; height:
23px;" colspan="5">&nbsp;</td>

<td class="column8 style31 null style33" style="border-color: #000000; width: 119px; height:
23px;" colspan="2">&nbsp;</td>

</tr>

<tr class="row15" style="height: 24px;">

<td class="column0 style37 s style37" style="border-color: #000000; width: 672px; height: 24px;
background-color: #757171;" colspan="10"><span style="font-family: helvetica, arial, sans-serif;
color: #ffffff;"><strong>III. ANTECEDENTES ESCOLARES</strong></span></td>

</tr>

<tr class="row16" style="height: 25px;">

<td class="column0 style38 s style40" style="border-color: #000000; background-color:

#d5edea;" colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">REPITENTE (SI O NO)</span></strong></td>

<td class="column3 style38 s style40" style="border-color: #000000; background-color:

#d5edea;" colspan="4"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;"><span style="color: #000000;">CURSOS QUE HA REPETIDO</span><span style="color:
#000000;">(E.G.B.)</span></span></strong></td>

<td class="column7 style25 s style25" style="border-color: #000000; background-color:

#d5edea;" colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">CURSOS QUE HA REPETIDO(E.M.)</span></strong></td>

</tr>

<tr class="row17" style="height: 23px;">

<td class="column0 style34 null style36" style="border-color: #000000; width: 199px; height:
23px;" colspan="3">&nbsp;</td>

<td class="column3 style34 null style36" style="border-color: #000000; width: 275px; height:
23px;" colspan="4">&nbsp;</td>

<td class="column7 style41 null style41" style="border-color: #000000; width: 198px; height:
23px;" colspan="3">&nbsp;</td>

</tr>

<tr class="row18" style="height: 25px;">

<td class="column0 style25 s style25" style="background-color: #d5edea;"

colspan="4"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">NOMBRE ESTABLECIMIENTO DE PROCEDENCIA</span></strong></td>

<td class="column4 style55 s style56" style="background-color: #d5edea;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">RELIGIÓN</span></strong></td>

<td class="column6 style21 s style21" style="background-color: #d5edea;"

colspan="4"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">FIRMA</span></strong></td>

</tr>

<tr class="row19" style="height: 23px;">

<td class="column0 style21 null style21" style="border-color: #000000; width: 289px; height:
23px;" colspan="4">&nbsp;</td>

<td class="column4 style57 null style57" style="border-color: #000000; width: 106px; height:
23px;" colspan="2">&nbsp;</td>
<td class="column6 style57 null style57" style="border-color: #000000; width: 277px; height:
23px;" colspan="4">&nbsp;</td>

</tr>

<tr class="row20" style="height: 25px;">

<td class="column0 style31 s style33" style="background-color: #d5edea;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">RECIBE PAE</span></strong></td>

<td class="column2 style2 s" style="background-color: #d5edea;"><strong><span style="font-

size: 10pt; font-family: helvetica, arial, sans-serif;">INTERNO</span></strong></td>

<td class="column3 style58 s style58" style="background-color: #d5edea;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">PERTENECE AL P.I.E</span></strong></td>

<td class="column5 style59 s style61" style="background-color: #d5edea;"

colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">PROGRAMA PUENTE/CHILE SOLIDARIO</span></strong></td>

<td class="column8 style53 s style54" style="background-color: #d5edea;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">PRIORITARIO</span></strong></td>

</tr>

<tr class="row21" style="height: 23px;">

<td class="column0 style27 null style27" style="border-color: #000000; width: 119px; height:
23px;" colspan="2">SI</td>

<td class="column2 style1 null" style="border-color: #000000; width: 80px; height:

23px;">&nbsp;</td>

<td class="column3 style34 null style36" style="border-color: #000000; width: 144px; height:
23px;" colspan="2">2555</td>

<td class="column5 style34 null style36" style="border-color: #000000; width: 210px; height:
23px;" colspan="3">&nbsp;</td>

<td class="column8 style34 null style36" style="border-color: #000000; width: 119px; height:
23px;" colspan="2">&nbsp;</td>

</tr>
<tr class="row22" style="height: 39px;">

<td class="column0 style21 s style21" style="background-color: #d5edea; width: 119px;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">BECA
BARE</span></strong></td>

<td class="column2 style25 s style25" style="background-color: #d5edea; width: 224px;"

colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">LOCOMOCION DEL ESTABLECIMIENTO</span></strong></td>

<td class="column5 style21 s style21" style="background-color: #d5edea; width: 131px;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">PRO
RETENCIÓN</span></strong></td>

<td class="column7 style12 s" style="background-color: #d5edea; width: 79px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">FONASA</span></strong></td>

<td class="column8 style12 s" style="background-color: #d5edea; width: 56px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">ISAPRE</span></strong></td>

<td class="column9 style12 s" style="background-color: #d5edea; width: 63px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">OTRO</span></strong></td>

</tr>

<tr class="row23" style="height: 23px;">

<td class="column0 style21 null style21" style="border-color: #000000; width: 119px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column2 style27 null style27" style="border-color: #000000; width: 224px; height:
23px;" colspan="3">&nbsp;</td>

<td class="column5 style31 null style33" style="border-color: #000000; width: 131px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column7 style2 null" style="border-color: #000000; width: 79px; height:

23px;">&nbsp;</td>

<td class="column8 style2 null" style="border-color: #000000; width: 56px; height:

23px;">&nbsp;</td>

<td class="column9 style2 null" style="border-color: #000000; width: 63px; height:

23px;">&nbsp;</td>

</tr>
<tr class="row24" style="height: 24px;">

<td class="column0 style37 s style37" style="border-color: #000000; width: 672px; height: 24px;
background-color: #757171;" colspan="10"><span style="font-family: helvetica, arial, sans-serif;
color: #ffffff;"><strong>IV. ANTECEDENTES DE SALUD</strong></span></td>

</tr>

<tr class="row25" style="height: 25px;">

<td class="column0 style31 s style33" style="background-color: #d5edea; width: 199px;"

colspan="3"><strong><span style="font-family: helvetica, arial, sans-
serif;">ENFERMEDADES</span></strong></td>

<td class="column3 style21 s style21" style="background-color: #d5edea; width: 144px;"

colspan="2"><strong><span style="font-family: helvetica, arial, sans-serif;">EN
TRATAMIENTO</span></strong></td>

<td class="column5 style62 s style64" style="background-color: #d5edea; width: 210px;"

colspan="3"><strong><span style="font-family: helvetica, arial, sans-serif; font-size:
10pt;">ALÉRGICO A MEDICAMENTOS</span></strong></td>

<td class="column8 style31 s style33" style="background-color: #d5edea; width: 119px;"

colspan="2"><strong><span style="font-family: helvetica, arial, sans-serif;">¿A CUAL?
</span></strong></td>

</tr>

<tr class="row26" style="height: 23px;">

<td class="column0 style27 null style27" style="border-color: #000000; width: 199px; height:
23px;" colspan="3">&nbsp;</td>

<td class="column3 style27 null style27" style="border-color: #000000; width: 144px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column5 style34 null style36" style="border-color: #000000; width: 210px; height:
23px;" colspan="3">&nbsp;</td>

<td class="column8 style27 null style27" style="border-color: #000000; width: 119px; height:
23px;" colspan="2">&nbsp;</td>

</tr>

<tr class="row27" style="height: 24px;">

<td class="column0 style37 s style37" style="border-color: #000000; width: 672px; height: 24px;
background-color: #757171;" colspan="10"><span style="font-family: helvetica, arial, sans-serif;
color: #ffffff;"><strong>V. ANTECEDENTES DEL GRUPO FAMILIAR</strong></span></td>

</tr>

<tr class="row28" style="height: 25px;">

<td class="column0 style65 s style70" style="background-color: #d5edea; width: 199px;"

colspan="3" rowspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial,
sans-serif;">PERSONAS CON QUIEN VIVE</span></strong>

<strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">&nbsp;EL

ALUMNO</span></strong></td>

<td class="column3 style71 s style74" style="background-color: #d5edea; width: 144px;"

colspan="2" rowspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial,
sans-serif;">CANTIDAD INTEGRANTES</span></strong>

<strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">GRUPO

FAMILIAR</span></strong></td>

<td class="column5 style21 s style21" style="background-color: #d5edea; width: 210px;"

colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">HERMANOS QUE ESTUDIAN</span></strong></td>

<td class="column8 style75 s style70" style="background-color: #d5edea; width: 119px;"

colspan="2" rowspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial,
sans-serif;">N° DE HERMANOS</span></strong></td>

</tr>

<tr class="row29" style="height: 25px;">

<td class="column5 style7 s" style="background-color: #d5edea; width: 52px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">E.G.B.</span></strong></td>

<td class="column6 style2 s" style="background-color: #d5edea; width: 79px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">E.M.</span></strong></td>

<td class="column7 style2 s" style="background-color: #d5edea; width: 79px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">E.S.</span></strong></td>

</tr>

<tr class="row30" style="height: 23px;">

<td class="column0 style34 null style36" style="border-color: #000000; width: 199px; height:
23px;" colspan="3">&nbsp;</td>

<td class="column3 style76 null style77" style="border-color: #000000; width: 144px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column5 style3 null" style="border-color: #000000; width: 52px; height:

23px;">&nbsp;</td>

<td class="column6 style3 null" style="border-color: #000000; width: 79px; height:

23px;">&nbsp;</td>

<td class="column7 style3 null" style="border-color: #000000; width: 79px; height:

23px;">&nbsp;</td>

<td class="column8 style76 null style77" style="border-color: #000000; width: 119px; height:
23px;" colspan="2">&nbsp;</td>

</tr>

<tr class="row31" style="height: 25px;">

<td class="column0 style31 s style33" style="background-color: #d5edea; width: 343px;"

colspan="5"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">NOMBRE DEL JEFE DE HOGAR DONDE VIVE EL ALUMNO</span></strong></td>

<td class="column5 style31 s style33" style="background-color: #d5edea; width: 210px;"

colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">PARENTESCO</span></strong></td>

<td class="column8 style31 s style33" style="background-color: #d5edea; width: 119px;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">TELEFONOS</span></strong></td>

</tr>

<tr class="row32" style="height: 23px;">

<td class="column0 style34 null style36" style="border-color: #000000; width: 343px; height:
23px;" colspan="5">&nbsp;</td>

<td class="column5 style34 null style36" style="border-color: #000000; width: 210px; height:
23px;" colspan="3">&nbsp;</td>

<td class="column8 style34 null style36" style="border-color: #000000; width: 119px; height:
23px;" colspan="2">&nbsp;</td>

</tr>
<tr class="row33" style="height: 25px;">

<td class="column0 style57 s style57" style="background-color: #d5edea; width: 66px;"

rowspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">PADRE</span></strong></td>

<td class="column1 style21 s style21" style="background-color: #d5edea; width: 133px;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">APELLIDO PATERNO</span></strong></td>

<td class="column3 style21 s style21" style="background-color: #d5edea; width: 144px;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">APELLIDO MATERNO</span></strong></td>

<td class="column5 style31 s style33" style="background-color: #d5edea; width: 210px;"

colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">NOMBRES</span></strong></td>

<td class="column8 style2 s" style="background-color: #d5edea; width: 56px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">R.U.N</span></strong></td>

<td class="column9 style7 s" style="background-color: #d5edea; width: 63px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">EDAD</span></strong></td>

</tr>

<tr class="row34" style="height: 23px;">

<td class="column1 style21 null style21" style="border-color: #000000; width: 133px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column3 style21 null style21" style="border-color: #000000; width: 144px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column5 style31 null style33" style="border-color: #000000; width: 210px; height:
23px;" colspan="3">&nbsp;</td>

<td class="column8 style1 null" style="border-color: #000000; width: 56px; height:

23px;">&nbsp;</td>

<td class="column9 style1 null" style="border-color: #000000; width: 63px; height:

23px;">&nbsp;</td>

</tr>

<tr class="row35" style="height: 25px;">

<td class="column0 style57 s style57" style="background-color: #d5edea; width: 66px;"
rowspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">MADRE</span></strong></td>

<td class="column1 style21 s style21" style="background-color: #d5edea; width: 133px;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">APELLIDO PATERNO</span></strong></td>

<td class="column3 style21 s style21" style="background-color: #d5edea; width: 144px;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">APELLIDO MATERNO</span></strong></td>

<td class="column5 style31 s style33" style="background-color: #d5edea; width: 210px;"

colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">NOMBRES</span></strong></td>

<td class="column8 style2 s" style="background-color: #d5edea; width: 56px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">R.U.N</span></strong></td>

<td class="column9 style7 s" style="background-color: #d5edea; width: 63px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">EDAD</span></strong></td>

</tr>

<tr class="row36" style="height: 23px;">

<td class="column1 style21 null style21" style="border-color: #000000; width: 133px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column3 style21 null style21" style="border-color: #000000; width: 144px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column5 style21 null style21" style="border-color: #000000; width: 210px; height:
23px;" colspan="3">&nbsp;</td>

<td class="column8 style4 null" style="border-color: #000000; width: 56px; height:

23px;">&nbsp;</td>

<td class="column9 style1 null" style="border-color: #000000; width: 63px; height:

23px;">&nbsp;</td>

</tr>

<tr class="row37" style="height: 25px;">

<td class="column0 style92 s style92" style="background-color: #d5edea; width: 289px;"

colspan="4"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">OCUPACIÓN DEL PADRE</span></strong></td>

<td class="column4 style92 s style92" style="background-color: #d5edea; width: 264px;"

colspan="4"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">OCUPACIÓN DE LA MADRE</span></strong></td>

<td class="column8 style93 s style93" style="background-color: #d5edea; width: 119px;"

colspan="2"><strong><span style="font-size: 8pt; font-family: helvetica, arial, sans-
serif;">INGRESO GRUPO FAMILIAR</span></strong></td>

</tr>

<tr class="row38" style="height: 25px;">

<td class="column0 style41 null style41" style="border-color: #000000; width: 289px; height:
25px;" colspan="4">&nbsp;</td>

<td class="column4 style41 null style76" style="border-color: #000000; width: 264px; height:
25px;" colspan="4">&nbsp;</td>

<td class="column8 style5 s" style="background-color: #d5edea; width: 56px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">$</span></strong></td>

<td class="column9 style6 null" style="border-color: #000000; width: 63px; height:

25px;">&nbsp;</td>

</tr>

<tr class="row39" style="height: 25px;">

<td class="column0 style57 s style57" style="background-color: #d5edea; width: 199px;"

colspan="3" rowspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial,
sans-serif;">ESCOLARIDAD DE LOS PADRES</span></strong></td>

<td class="column3 style7 s" style="background-color: #d5edea; width: 90px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">PADRE</span></strong></td>

<td class="column4 style7 s" style="background-color: #d5edea; width: 54px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">BÁSICA</span></strong></td>

<td class="column5 style7 null" style="border-color: #000000; width: 52px; height:

25px;">&nbsp;</td>

<td class="column6 style7 s" style="background-color: #d5edea; width: 79px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">MEDIA</span></strong></td>

<td class="column7 style1 null" style="border-color: #000000; width: 79px; height:

25px;">&nbsp;</td>

<td class="column8 style7 s" style="background-color: #d5edea; width: 56px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">UNIV.</span></strong></td>

<td class="column9 style7 null" style="border-color: #000000; width: 63px; height:

25px;">&nbsp;</td>

</tr>

<tr class="row40" style="height: 25px;">

<td class="column3 style7 s" style="background-color: #d5edea; width: 90px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">MADRE</span></strong></td>

<td class="column4 style7 s" style="background-color: #d5edea; width: 54px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">BÁSICA</span></strong></td>

<td class="column5 style7 null" style="border-color: #000000; width: 52px; height:

25px;">&nbsp;</td>

<td class="column6 style7 s" style="background-color: #d5edea; width: 79px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">MEDIA</span></strong></td>

<td class="column7 style1 null" style="border-color: #000000; width: 79px; height:

25px;">&nbsp;</td>

<td class="column8 style8 s" style="background-color: #d5edea; width: 56px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">UNIV.</span></strong></td>

<td class="column9 style8 null" style="border-color: #000000; width: 63px; height:

25px;">&nbsp;</td>

</tr>

<tr class="row41" style="height: 25px;">

<td class="column0 style78 s style78" style="background-color: #d5edea; border-color:

#000000;" colspan="7"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">RECIBE Y ACEPTA</span></strong></td>

<td class="column7 style79 s style81" style="border-color: #000000; width: 198px; height:

25px;" colspan="3"><strong><span style="font-family: helvetica, arial, sans-
serif;">FIRMA</span></strong></td>

</tr>

<tr class="row42" style="height: 25px;">

<td class="column0 style82 s style82" style="background-color: #d5edea; border-color:
#000000;" colspan="6"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">REGLAMENTO DE CONVIVENCIA ESCOLAR</span></strong></td>

<td class="column6 style9 null" style="border-color: #000000;">&nbsp;</td>

<td class="column7 style83 null style91" style="border-color: #000000; width: 198px; height:
75px;" colspan="3" rowspan="3">&nbsp;</td>

</tr>

<tr class="row43" style="height: 25px;">

<td class="column0 style82 s style82" style="background-color: #d5edea; border-color:

#000000;" colspan="6"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">REGLAMENTO DE EVALUACIÓN</span></strong></td>

<td class="column6 style9 null" style="border-color: #000000;">&nbsp;</td>

</tr>

<tr class="row44" style="height: 25px;">

<td class="column0 style82 s style82" style="background-color: #d5edea; border-color:

#000000;" colspan="6"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">PROYECTO EDUCATIVO INSTITUCIONAL</span></strong></td>

<td class="column6 style9 null" style="border-color: #000000;">&nbsp;</td>

</tr>

<tr class="row45" style="height: 24px;">

<td class="column0 style37 s style94" style="border-color: #000000; width: 672px; height: 24px;
background-color: #757171;" colspan="10"><span style="color: #ffffff;"><strong><span
style="font-family: helvetica, arial, sans-serif;">VI. ANTECEDENTES DE LOS
APODERADOS(AS)</span></strong></span></td>

</tr>

<tr class="row46" style="height: 51px;">

<td class="column0 style25 s style25" style="background-color: #d5edea; width: 199px;"

colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">NOMBRE DEL APODERADO(A) TITULAR</span></strong></td>

<td class="column3 style12 s" style="background-color: #d5edea; width: 90px;"><strong><span

style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">PARENTESCO</span></strong></td>

<td class="column4 style25 s style25" style="background-color: #d5edea; width: 106px;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">DOMICILIO</span></strong></td>

<td class="column6 style25 s style95" style="background-color: #d5edea; width: 158px;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">TELEFONOS</span></strong></td>

<td class="column8 style96 s style97" style="background-color: #d5edea; width: 119px;"

colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">FIRMA</span></strong></td>

</tr>

<tr class="row47" style="height: 23px;">

<td class="column0 style98 null style98" style="border-color: #000000; width: 199px; height:
23px;" colspan="3">&nbsp;</td>

<td class="column3 style10 null" style="border-color: #000000; width: 90px; height:

23px;">&nbsp;</td>

<td class="column4 style98 null style98" style="border-color: #000000; width: 106px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column6 style98 null style99" style="border-color: #000000; width: 158px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column8 style96 null style97" style="border-color: #000000; width: 119px; height:
23px;" colspan="2">&nbsp;</td>

</tr>

<tr class="row48" style="height: 51px;">

<td class="column0 style92 s style92" style="background-color: #d5edea;"

colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">DÓNDE TRABAJA PRINCIPALMENTE</span></strong></td>

<td class="column3 style13 s" style="background-color: #d5edea;"><strong><span style="font-

size: 10pt; font-family: helvetica, arial, sans-serif;">EN EL HOGAR</span></strong></td>

<td class="column4 style11 null" style="border-color: #000000;">&nbsp;</td>

<td class="column5 style38 s style40" style="border-color: #000000; background-color:

#d5edea;" colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">FUERA DEL HOGAR</span></strong></td>

<td class="column7 style11 null" style="border-color: #000000;">&nbsp;</td>

<td class="column8 style14 s" style="border-color: #000000; background-color:

#d5edea;"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-serif;">NO
TRABAJA</span></strong></td>

<td class="column9 style11 null" style="border-color: #000000;">&nbsp;</td>

</tr>

<tr class="row49" style="height: 51px;">

<td class="column0 style100 s style100" style="border-color: #000000; background-color:

#d5edea;" colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">NOMBRE DEL APODERADO(A) SUPLENTE</span></strong></td>

<td class="column3 style15 s" style="border-color: #000000; background-color:

#d5edea;"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">PARENTESCO</span></strong></td>

<td class="column4 style100 s style100" style="border-color: #000000; background-color:

#d5edea;" colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">DOMICILIO</span></strong></td>

<td class="column6 style100 s style101" style="border-color: #000000; background-color:

#d5edea;" colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">TELEFONOS</span></strong></td>

<td class="column8 style102 s style103" style="border-color: #000000; background-color:

#d5edea;" colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">FIRMA</span></strong></td>

</tr>

<tr class="row50" style="height: 23px;">

<td class="column0 style98 null style98" style="border-color: #000000; width: 199px; height:
23px;" colspan="3">&nbsp;</td>

<td class="column3 style10 null" style="border-color: #000000; width: 90px; height:

23px;">&nbsp;</td>

<td class="column4 style98 null style98" style="border-color: #000000; width: 106px; height:
23px;" colspan="2">&nbsp;</td>
<td class="column6 style98 null style98" style="border-color: #000000; width: 158px; height:
23px;" colspan="2">&nbsp;</td>

<td class="column8 style25 null style25" style="border-color: #000000; width: 119px; height:
23px;" colspan="2">&nbsp;</td>

</tr>

<tr class="row52" style="height: 24px;">

<td class="column0 style104 s style104" style="border-color: #000000; width: 289px; height:

24px; background-color: #d5edea;" colspan="4"><strong><span style="font-family: helvetica,
arial, sans-serif;">FUNCIONARIO QUE REALIZA LA MATRICULA</span></strong></td>

<td class="column4 style27 null style27" style="border-color: #000000; width: 383px; height:
24px;" colspan="6">&nbsp;</td>

</tr>

<tr class="row53" style="height: 24px;">

<td class="column0 style94 s style94" style="border-color: #000000; width: 672px; height: 24px;
background-color: #757171;" colspan="10"><span style="color: #ffffff;"><strong><span
style="font-family: helvetica, arial, sans-serif;">VII. RETIRO</span></strong></span></td>

</tr>

<tr class="row54" style="height: 25.1563px;">

<td class="column0 style105 s style105" style="border-color: #000000; background-color:

#d5edea;" colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">FECHA</span></strong></td>

<td class="column2 style105 s style105" style="border-color: #000000; background-color:

#d5edea;" colspan="2"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">MOTIVO</span></strong></td>

<td class="column4 style106 s style107" style="border-color: #000000; background-color:

#d5edea;" colspan="3"><span style="font-size: 8pt;"><strong><span style="font-family:
helvetica, arial, sans-serif;">NOMBRE QUIEN RETIRA
DOCUMENTOS</span></strong></span></td>

<td class="column7 style108 s style110" style="border-color: #000000; background-color:

#d5edea;" colspan="3"><strong><span style="font-size: 10pt; font-family: helvetica, arial, sans-
serif;">FIRMA</span></strong></td>

</tr>
<tr class="row54" style="height: 25.1563px;">

<td class="column0 style105 s style105" style="border-color: #000000; width: 119px; height:

25.1563px;" colspan="2">&nbsp;</td>

<td class="column2 style105 s style105" style="border-color: #000000; width: 170px; height:

25.1563px;" colspan="2">&nbsp;</td>

<td class="column4 style106 s style107" style="border-color: #000000; width: 185px; height:

25.1563px;" colspan="3">&nbsp;</td>

<td class="column7 style108 s style110" style="border-color: #000000; width: 198px; height:

25.1563px;" colspan="3">&nbsp;</td>

</tr>

</tbody>

</table>

&nbsp;