UNIVERSITATEA TRANSILVANIA DIN BRAOV

FACULTATEA _______________________________

CERERE DE NSCRIERE LA EXAMENUL DE _______________________

I. Date personale ale candidatului/ candidatei

1. Date privind identitatea persoanei

Numele de natere:__________________________ Numele (dac este cazul):_____________________
Prenumele: ________________________________ CNP ___________________________________
2. Sexul: Feminin Masculin
3. Data i locul naterii:
Ziua / luna / anul ________ /_________________ / __________
Locul (localitate, jude, ara) _________________ / ____________________/ __________________
4. Prenumele prinilor:
Tata: ____________________________ Mama:____________________________________
5. Domiciliul stabil: Localitatea _____________________, jud. ______________Cod potal _______,
str. ______________________________________ nr._____, bloc _____, sc.____, et. ____, ap.____,
Telefon _______________, mail _________________

II. Date privind colarizarea

6. Sunt absolvent() promoia: ______ / _______ (anul nmatriculrii / anul absolvirii)
7. Meniuni privind colarizarea: ___________________________________________________
________________________________________________________________________________
8. Programul de studii ____________________________________________________________
9. Durata studiilor ________________________________________________________________
10. Forma de nvmnt absolvit: IF IFR ID
Fr tax Cu tax
11. Solicit nscrierea la examenul de __________, sesiunea _________________ anul __________
12. Lucrarea/ Proiectul de _____________________ pe care o susin are urmtorul titlu:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
13. Coordonator tiinific:__________________________________________________________
14. Menionez c susin examenul de ____________ (pentru prima oar, a doua oar - dup caz)
_________________________________

SEMNTURA, VERIFICAT,
Secretar facultate
_________________________________ ____________________
(numele i prenumele, semntura)

F06-PS 7.6-01/ed.2,rev.1