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Anexa 3
AVIZAT,
Conductor de doctorat,
___________________
FIA DE NSCRIERE
pentru concursul de admitere la doctorat
Domeniul _____________________________________________________
Conductor tiinific _____________________________________________
1.Numele i prenumele cu iniiala tatlui______________________________________________
______________________________________________________________________________
2.Domiciliul stabil (adresa complet) _________________________________________________
_____________________________________________________________________ nr. ______
telefon mobil ______________________________ nr. telefon fix _________________________
adresa de e-mail ___________________________
3.Naionalitatea_________________________, etnia ___________________________________
4.Data naterii (anul, luna, ziua) ____________________________________________________
5.Locul
naterii:
judeul____________________________
oraul
(municipiul,
instituia
de
nvmnt
superior,
facultatea,
specializarea
absolvit,
anul,
domeniul:______________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
11.Limbi strine cunoscute : _______________________________________________________
12.Candidat care se ncadreaz n categoria persoanelor cu dizabiliti (se completeaz numai de
persoanele
aflate
aceast
situaie,
pe
baz
documente)__________________________________
Data,
Semntura,
_______________
____________________
de