Borrador CUESTIONARIO PARA HIJ@S DE LA MEMORIA CHILE

DESEA SER PARTICIPE?

SI

NO

NECESITO MAS INFORMACION

TIPO DE PARTICIPACION
AUTOR
OTRO

COLABORADOR

INFORMADOR-TESTIGO

VICTIMA

DATOS PERSONALES

NOMBRES ________________________________________________________________
APELLIDO PATERNO _________________________________________________________
APELLIDO MATERNO ________________________________________________________
FECHA DE NACIMIENTO ______________________________________________________
LUGAR DE NACIMIENTO ______________________________________________________
LOCALIDAD DE RESIDENCIA ___________________________________________________
PAIS DE RESIDENCIA ________________________________________________________
NACIONALIDAD ____________________________________________________________
ORIGEN ______________________________________________________________
OPCION ______________________________________________________________
OTRA ________________________________________________________________
OTRA NACIONALIDAD _______________________________________________________
PROFESION ________________________________________________________________
LUGAR DE TRABAJO ________________________________________________________
RELACION CON EL EXILIO _____________________________________________________
NOMBRE PADRE _______________________________________________________
LUGAR NACIMIENTO PADRE _______________________________________________
NOMBRE MADRE _______________________________________________________
LUGAR NACIMIENTO MADRE ______________________________________________
CORREO ELECTRONICO _____________________________________________________
MESSENGER _

FACEBOOK
TWITTER
OTRAS REDES SOCIALES______________________________________________________________
LOCALIDAD _______________________________________________________________
PAIS _____________________________________________________________________
TELEF FIJO _________________________________________________________________
TELEFONO MOVIL __________________________________________________________
SITIOS/blog WEB _______________________________________________________________

PARTICIPACIN EN ACTIVIDADES
Online y/offline

DDHH

On line

Off line

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MEMORIA

On line

Off line

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CIUDADANA

On line

Off line

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CAUSAS

On line

Off line

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CULtURALES

On line

Off line

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POLITICAS

On line

Off line

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SOCIALES

On line

Off line

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ACADEMICA

On line

Off line

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OTRAS

On line

Off line

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PARTICIPACION EN LA PUBLICACIN COLECTIVA:

MEMORIAS PREADAS o A VIVAS VOCES
SU APORTE

REFLEXION
TESTIMONIO
ACADEMICOS
ARTICULOS
LITERATURA
DIARIO DE VIDA
AUDIOVISUAL
DOCUMENTAL
MUSICA
GRAFICA
OPININ COMENTARIO
SUGERENCIA

HISTORIA DE VIDA
ESTRACTO TESIS
OTRO
CUENTO
POESIA
CINE
TESIS
TEATRO
ARTESANIAS

CARTAS PERSONALES
(Indita __ publicada ___ )
ANECDOTAS
MONOGRAFIA
NOVELA
ENSAYO
VIDEO
FOTOGRAFIA
OTRAS