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________________________________________________________________________ DECLARAÇÃO Declaro, para os devidos fins, que o(a) aluno(a) ________________________, regularmente matriculado(a) no Curso de xxxxxx da IES: xxx, campus________, cumpriu _____ horas de Estágio Supervisionado, no período de ___/___/___ a ___/___/___, no local:___________________________________ onde desenvolveu as seguintes atividades: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________. ____________________, _____ de _________ de __________. __________________________________________ Assinatura e carimbo do supervisor image1.png