This document is a form for students to provide information about their teaching practicum or internship. It requests the student's name, partner's name, email, name and address of the school, contact information for the school, name and contact information for their supervisor, the supervisor's employee ID number at the school, and the start date for the practicum. The supervisor must also sign the form.

1. SERVIÇO PÚBLICO FEDERAL
UNIVERSIDADE FEDERAL DE PERNAMBUCO
CENTRO DE EDUCAÇÃO
DEPARTAMENTO DE MÉTODOS E TÉCNICAS DE ENSINO
DISCIPLINA: PRÁTICA DE ENSINO DE HISTÓRIA II – 2012.1
PROFESSORA NATÁLIA CONCEIÇÃO SILVA BARROS
FICHA DE ESTÁGIO
NOME:_______________________________________________________________________
PARCEIRO (A) DE ESTÁGIO: ____________________________________________________
E-MAIL:_______________________________________________________________________
NOME DA ESCOLA CAMPO: (informe se é estadual ou municipal)
_____________________________________________________________________________
ENDEREÇO DA ESCOLA
CAMPO:______________________________________________________________________
TELEFONES E E-MAIL DA ESCOLA CAMPO:
_____________________________________________________________________________
NOME DO (A) SUPERVISOR (A):__________________________________________________
E-MAIL DO (A) SUPERVISOR (A):_________________________________________________
TELEFONE CELULAR DO (A) SUPERVISOR (A):_____________________________________
Nº DA MATRÍCULA DO (A) SUPERVISOR (A) NA ESCOLA
CAMPO:______________________________________________________________________
DATA DE INÍCIO DO ESTÁGIO: ___________________________________________________
ASSINATURA DO SUPERVISOR:__________________________________________________