This document appears to be an attachment to an application for admission to a specialization program in Memory, Identity and Material Culture at the Federal University of Pelotas in Brazil. It includes fields for the applicant to provide their name, ID number, CPF (Brazilian tax ID), chosen research line between Material and Immaterial Heritage or Memory and Social Identity, and the title of their preliminary research project proposal. Contact information is also provided for the program director, vice-director and secretary.

1. MINISTÉRIO DA EDUCAÇÃO
UNIVERSIDADE FEDERAL DE PELOTAS
INSTITUTO DE CIÊNCIAS HUMANAS
ESPECIALIZAÇÃO EM MEMÓRIA, IDENTIDADE E CULTURA MATERIAL
ICH – Campus 1 – Rua Coronel Alberto Rosa 154 CEP 96010-770 Tel: 3284 5523
ICH – Campus 2 – Rua Marechal Floriano, 177 CEP:96015-440 Tel: 3222 3209
ICH – Campus 3 – Rua Gonçalves Chaves, 660 CEP 96015-560
ICH – Campus 4 – Rua Gomes Carneiro,1 (4º.andar) CEP: 96010-610
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Anexo 1 ao EDITAL PARA EXAME DE SELEÇÃO 2012
DATA: __________________.
NOME: _____________________________________________________________.
DOC. ID.: __________________. CPF: __________________.
LINHA DE PESQUISA ESCOLHIDA:
PATRIMÔNIO MATERIAL E IMATERIAL MEMÓRIA E IDENTIDADE SOCIAL
TÍTULO DO ANTEPROJETO:
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ASSINATURA:
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Diretor: Sidney Gonçalves Vieira / Cel: 81187299 / E-Mail: sid_geo@hotmail.com
Vice-Diretora: Lorena Almeida Gill / Cel: 84038945 / E-Mail: lorenaalmeidagill@gmail.com
Secretário: Mário Ayres da Silveira / E- Mail: iocri@hotmail.com
Rua Alberto Rosa, 154 CEP 96010-770 Pelotas/RS Tel/Fax +55(53)3284-5523