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Curso: _______________________________________________________________________________ Matrcula: _________________ Perodo: _____ CRE: __________ Data de nascimento: ___/___/______ Contato telefnico:_____________________________________________________________________ Contato email: ________________________________________________________________________ Disponibilidade (horrio livre semanal): SEG ___M ___T/ TER ___M ___T/ QUA ___M ___T/ QUI ___M ___T/ SEX ___M ___T Obs: _________________________________________________________________________________ rea de interesse: __Pesquisa __Extenso __Ambos Porque se interessa por acessibilidade? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Tem experincia em laboratrio? (foi bolsista?) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Tem artigos publicados? __SIM __NO. Onde? Qual? _____________________________________________________________________________________ _____________________________________________________________________________________