FICHA DE INSCRIÇÃO PLENÁRIA REGIONAL SUL – RIO GRANDE  28 a 30 junho de 2012.
Autor: Professora Ingrid Costa | Publicado: 2012-06-18T07:01:00-07:00

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FICHA DE INSCRIÇÃO PLENÁRIA REGIONAL
SUL – RIO GRANDE

28 a 30 junho de 2012.

 

  
  
Nome:

 

  
  
Instituição que representa:

 

  
  
Profissão:

 

  
  
Instrução: (&nbsp;&nbsp;&nbsp;&nbsp; ) Ensino Fundamental (&nbsp;&nbsp;&nbsp;&nbsp; ) Ensino Médio (&nbsp;&nbsp;&nbsp;&nbsp; ) Superior Inc. (&nbsp;&nbsp;&nbsp;&nbsp; ) Superior Comp. (&nbsp;&nbsp;&nbsp;&nbsp; ) Especialização ( &nbsp;&nbsp;&nbsp;&nbsp;) Mestrado (&nbsp;&nbsp;&nbsp;&nbsp; ) Doutorado (&nbsp;&nbsp;&nbsp;&nbsp; ) Pós-doutorado.

 

  
  
Segmento:

(&nbsp;&nbsp;&nbsp;&nbsp; ) Secretaria Estadual de Educação (&nbsp;&nbsp;&nbsp;&nbsp; ) Secretaria Municipal de Educação
  (&nbsp;&nbsp;&nbsp;&nbsp; ) Secretaria de Justiça ou/e
  Direitos Humanos (&nbsp;&nbsp;&nbsp;&nbsp; ) Ministério
  Público Estadual (&nbsp;&nbsp;&nbsp;&nbsp; ) Universidade
  Pública (&nbsp;&nbsp;&nbsp;&nbsp; ) Universidade Privada
  (&nbsp;&nbsp;&nbsp;&nbsp; ) Escola Pública Estadual (&nbsp;&nbsp;&nbsp;&nbsp; ) Escola Pública Municipal (&nbsp;&nbsp;&nbsp;&nbsp; ) Escola Privada (&nbsp;&nbsp;&nbsp;&nbsp; ) Sindicato de Professores de Escolas
  Públicas (&nbsp;&nbsp;&nbsp;&nbsp; ) Sindicato de
  Professores de Escolas Municipais (&nbsp;&nbsp;&nbsp;&nbsp;
  ) Sindicato de Professores de Escolas Privadas (&nbsp;&nbsp;&nbsp;&nbsp; ) Sindicato de Proprietarios de Escolas
  Privadas &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;(&nbsp;&nbsp;&nbsp;&nbsp; ) Coordenaçao de Igualdade Racial (&nbsp;&nbsp;&nbsp;&nbsp; ) CEFET (&nbsp;&nbsp;&nbsp;&nbsp; ) Movimento Negro Organizado &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;&nbsp;(&nbsp;&nbsp;&nbsp;&nbsp; ) Associações (&nbsp;&nbsp;&nbsp;&nbsp; ) Conselhos de Educação (&nbsp;&nbsp;&nbsp;&nbsp; ) Comunidade Quilombola (&nbsp;&nbsp;&nbsp;&nbsp; ) Indigena &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(&nbsp;&nbsp;&nbsp;&nbsp; ) Especialização em Religião de Matriz
  Africana (&nbsp;&nbsp;&nbsp;&nbsp; ) Entidades Culturais
  (&nbsp;&nbsp;&nbsp;&nbsp; ) Outras.&nbsp;&nbsp;&nbsp;&nbsp; 

 

  
  
Endereço:

 

  
  
Cidade:

 

  
  
Bairro:

 

  
  
CEP:&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;&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;&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;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;UF:

 

  
  
e-mail:

 

  
  
Telefone fixo:
  (&nbsp;&nbsp;&nbsp;&nbsp; )_________________________ Fax:
  (&nbsp;&nbsp;&nbsp;&nbsp; )___________________________

Telefone celular: (&nbsp;&nbsp;&nbsp;&nbsp; )________________________

 

  
  
Data:&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;&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;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Local:

 

  
  
Assinatura: