Qualification Statement

Team Members

UG=Undergraduated; G=Graduated

1.

Name: _________________________________________________________________

ID: ________________________________ CPF: _______________________________

Course: _________________________________________________ UG: ____ G: ____

2.

Name: _________________________________________________________________

ID: ________________________________ CPF: _______________________________

Course: _________________________________________________ UG: ____ G: ____

3.

Name: _________________________________________________________________

ID: ________________________________ CPF: _______________________________

Course: _________________________________________________ UG: ____ G: ____

School Advisor

Name: _________________________________________________________________

ID: _______________________________ CPF: ______________________________

Position: ________________________________________________________________

Coach (do not fill if is the same as the school advisor)

Name: __________________________________________________________________

ID: _______________________________ CPF: ______________________________

School

Name: __________________________________________________________________

Address: _______________________________________________________________

City: ___________________________________ state: _____ zipcode: ____________

phone: ______________________ e-mail:____________________________________

Unidade of the school advisor: ____________________________________________


I guarantee that all information above is correct and that all cited students attend the requirements for participating according to the contest rules.

___________________________________

School Advisor's Signature