INSTITUCIN EDUCATIVA CRISTIANA

INTERNACIONAL ELIM

DECLARACIN TEXTUAL DEL ESTUDIANTE

Fecha: ___/___/_____

Arequipa, a horas ________ del da ________ de _________________ del 2017, en

las Instalaciones de la Institucin Cristiana Internacional Elim la
encargada del Dpto. de Psicopedagoga Bach. Ps. Anglica Andrade Ziga
toma la declaracin textual sobre _______________________________ del
estudiante _________________________________ del Grado y Seccin
_____________ del Nivel _____________, quien declara lo siguiente:

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Formando Alumnos con Futuro

INSTITUCIN EDUCATIVA CRISTIANA
INTERNACIONAL ELIM

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Formando Alumnos con Futuro