- SERVIZIO TERRITORIALE DI BASE SEDE CENTRALE Via Rocca de’ Baldi 7 Borgo San Giuseppe 12100 Cuneo' 017134.71.74//756 017134.71.76 - [email protected] Cuneo, ____________ Prot. n._____________ Titolo____ Classe____ Allegati ___________ PROGETTO DI COLLABORAZIONE TRA SERVIZIO TERRITORIALE DI BASE E SCUOLA Nominativo minore: __________________________________________ Data e luogo di nascita: ________________________________________________________ Luogo di residenza: ___________________________________________________________ Obiettivi del progetto: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Progetto di intervento (tipologia, tempi di attuazione): • Servizio Territoriale di Base: ___________________________________________________________________________ ___________________________________________________________________________ • Scuola: ___________________________________________________________________________ ___________________________________________________________________________ Modalità e tempi di verifica: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ data ______________ Servizio Territoriale di Base: _______________________ Scuola: _______________________ _______________________ _______________________ CONSORZIO SOCIO ASSISTENZIALE DEL CUNEESE VERIFICA DEL PROGETTO IN DATA ________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ EVENTUALI MODIFICHE DEGLI OBIETTIVI. ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ data_______________ Servizio Territoriale di Base: Scuola: _______________________ _______________________ _______________________ _______________________ 2