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DEPARTAMENTO DE REGISTRO E CONTROLE ACADMICO - DERCA

REQUERIMENTO
NOME (LEGVEL) :_____________________________________________________________________________________________
ENDEREO :___________________________________________________ BAIRRO: ______________________________________
CEP :_______________ - _______ E-mail:_____________________________________ FONE(S): ___________________________
MATRICULA :____________________________________

CPF: _______.________._______-______

CURSO :______________________________________________________________________________________________________

Vem requerer junto a Vossa Senhoria:


Declarao:

Transferncia Ex-Offcio p/ o Curso de:

Histrico Escolar:

______________________________________

_________________________________________

Diploma de Graduao:

Cancelamento por disciplina:


Cdigo

______________________________________

Trancamento do Semestre Letivo:


______________________________________

Turma

Cdigo

Turma

__________________ | ____________________

__________________ | ____________________

__________________ | ____________________

__________________ | ____________________

__________________ | ____________________

__________________ | ____________________

Trancamento por disciplina:


Reviso do Histrico Escolar (especificar):

Cdigo

______________________________________
______________________________________
______________________________________
______________________________________

Cdigo

Turma

__________________ | ____________________

__________________ | ____________________

__________________ | ____________________

__________________ | ____________________

__________________ | ____________________

__________________ | ____________________

Outros (especificar):

Cancelamento do Curso (Especificar):

______________________________________

______________________________________
Conforme 3 do Art. 65 do Regime Geral da UFRR:

Turma

______________________________________
______________________________________
______________________________________

Boa Vista, _____ de ______________de __________.

_________________________________________
ASSINATURA DO REQUERENTE

______________________________________
______________________________________
______________________________________
____________________________________________
ASSINATURA DO RESPONSVEL - DERCA

............................................................................................................................................................................................
REQUERIMENTO
NOME (LEGVEL) :_____________________________________________________________________________________________
Tipo de solicitao: ___________________________________________________ Curso______________________________________
Boa Vista, _____ de ______________de __________.
____________________________________________

COMPROVANTE DO ALUNO

ASSINATURA DO RESPONSVEL - DERCA

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