UNIVERSITATEA TRANSILVANIA din BRAOV

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,

comuna)________________________________________________________________, sex M/F

6.Starea civil __________________________________________________________________
7.Profesia de baz_______________________________________________________________
8.Locul de munc: _______________________________________________________________
9.Funcia ______________________________________________________________________
10.Studii:

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