REPÚBLICA DE MOÇAMBIQUE

SECRETARIA DE ESTADO DA JUVENTUDE E EMPREGO

INSTITUTO NACIONAL DA JUVENTUDE

FICHA DE CANDIDATURA AO PRÉMIO JOVEM CRIATIVO

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1. Dados Pessoais

Nome completo:________________________________________________________________

Sexo: ( ) Masculino ( ) Feminino

Data de Nascimento: ___/____/_____

Filiação:_______________________________________________________________________
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Naturalidade:_____________________________ Nacionalidade:_________________________

Ocupação: ( ) Estudante
( )Comerciante
( ) Trabalhador
( ) Outros
Especifique:___________________________________________________________________
Morada:________________________________________________________________

Localidade:____________________________________________________________________
2. Categoria do Concurso

Empreendedorismo ( )
Inovação tecnológica ( )
Criação Artística ( )

3. Descrição do objecto Criado

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4. Contactos:

Telefones:_______________________________
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Email: __________________________________

Outros:__________________________________

Data:_____________________ Assinatura:

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