Revised 09/2009

Click on the form to activate text boxes. Use the Tab key to move from one box to the next. Press the X key to check boxes. Text boxes will automatically expand to accommodate the size of the text. The final length of the form should be approximately two full pages.

Child Departure Form

Departure

Check this box for departures which occur based on circumstances outside of the pro ect!s control. "or example# a child moves or the child!s family no longer needs assistance from the pro ect.

Program Completion

Check this box for departures which are known in advance. "or example# a child graduating from school or becoming too old to participate in the pro ect.

Todays date $month%day%year& : 8 de octubre/2013 1. Project number: DO 10! 3. First or common name: #t$en %. Second or middle name: &nmanuel !. Family name, surname, or last name: 'oncion ". Gender: ale Female

Form completed by: Andrea Rodriguez 2. Child ID number (required): C312""8

(. Date o! birth $month%day%year& : 1) de marzo 2003

8. Date o! departure $month%day%year& : _________________________________________________________

DEPARTURE INFORMATION Do not complete D1-D2 i

t!e "o# m$r%ed Pro&r$m 'ompletion i( c!ec%ed) 'elect $ll that apply. (ach box marked re)uires a detailed explanation on line *+.

D1. Departure reason: child has gone to li"e #ith other relati"es !amily mo"ed !rom project area !amily no# able to pro"ide !or the child project too !ar !or the child to attend ta$en out o! the program by parents lac$ o! interest or commitment child is needed to help their !amily child is no# employed trans!erred to a di!!erent school !ailed school courses death o! child illness pregnancy child has married other: ________________ D2. Pro"ide a detailed e%planation o! all departure reasons chec$ed abo"e (required): *a madre lo +aco por,ue para lle$arlo a otro lugar donde lo $an a tener como ni-o interno D3. Pro"ide a detailed e%planation o! the childs ne# situation, i! $no#n: &l ni-o +igue en la mi+ma +ituacion economica

PRO*RAM 'OMP+ETION INFORMATION Do not complete P'1 i

t!e "o# m$r%ed Dep$rture i( c!ec%ed)

.C1. Pro"ide a detailed e%planation o! the childs ne# situation #hich #ill occur !ollo#ing the childs satis!actory completion o! the program o!!ered (required): _____________________________________________________________________________________ _____________________________________________________________________________________

RE,U+T, OF '-I+D., IN/O+/EMENT #./R/01A* /'.AC0

#1. Child is a Christian $select one&: &es 'o (n$no#n #2. Did child become a Christian #hile in the sponsorship program)

Comments: &es 'o (n$no#n

#3. 'elect $ll that apply, Child sho#s some $no#ledge o! the Christian !aith* Child sometimes participates in Christian acti"ities, but does not lead those acti"ities* Child sho#s some e"idence o! Christian !aith and beha"ior*
Child Departure Form Page + o! ,

Revised 09/2009

Child has Scripture materials #%. Pro"ide a detailed e%planation o! the childs Christian e%perience (required): 2o 3ue lider pero tu$o conocimiento cri+tiano aprendio alguno+ coro+ 4 te5to+ biblico+.

.67#/CA* /'.AC0
.1. 'ote any illnesses the child had during their participation in the program as #ell as #hat the childs current health is (required): #olo na herida 4 +e le a4udo con lo+ medicamento+

#OC/A* 8 &'O0/O2A* /'.AC0

#&1. -as the child matured appropriately !or their age) &es 'o #&2. Pro"ide a brie! e%planation o! the childs le"el o! maturity and ho# they relate to others around them (required): &l ni-o le gu+ta compartir con todo+ grande+ 4 pegue-o+

CO92/0/:& /'.AC0
/1. .cademics / highest class le"el completed $select one&: pre/school $indergarten primary school: ________ secondary school: _______ "ocational school / course o! study: ________ apprenticeship / course o! study: _______ other: _________ /2. S$ills child is trained in $select each box which applies&: basic numeracy basic literacy thin$ing and problem/sol"ing s$ills sel!/help s$ills entrepreneurial 0business1 s$ills li!e s$ills "ocational or technical s$ills other: _____________________

*ENERA+ 'OMMENT,
C1. Summari2e the projects o"erall impact on the childs li!e and pro"ide any additional comments (required): la madre del ni-o di;o ,ue el ni-o caminaba mucho 4 lo iba a lle$ar a un lugar donde lo de;aran interno.

Child Departure Form

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