Stage en période scolaire

Demande de stage en période scolaire

Prénom et nom*
Prénom Nom
Sexe*
- Masculin
- Féminin
Adresse*
Adresse postale Ville État / Province / Région ZIP / Code postal Pays
Téléphone*
E-mail*
Date de naissance*
Format de date :JJ slash MM slash AAAA
Type d'étude*
- De plein exercice
- Promotion sociale
Option*
Nom de l'établissement*
Année d'étude*
Date début de stage*
Format de date :JJ slash MM slash AAAA
Date de fin de stage*
Format de date :JJ slash MM slash AAAA
Nombre d'heures à prester*
Objectifs personnels de stage*

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