Subsemnatul (a) ____________________________________________ , student () a facultii _____________________ , anul
de studiu ____ , seria _____ , grupa ______ , n vederea evalurii finale optez pentru urmtoarea tem (titlul complet al temei + numrul de ordine din list): _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ ____________________________________________ Date de contact: Email: ______________________________________ Tel (fix / mobil): ________________________________ Solicit ca ndrumtor tiinific pentru elaborarea temei pe doamna / domnul (cadru didactic al D.P.P.D.): __________________________________ Data: