APROBAT,

Prorector Prof. Dr. Grigore Bciu

CERERE DETAARE

Ctre,
Prorectoratul de Studii Postuniversitare i Rezideniat

Subsemnatul(a)______________________________________________
CNP ______________________, nscut() n localitatea __________________,
jud. ______ absolvent al Universitii __________________________________
medic rezident (post / loc / timp par.)_____,anul_____ specialitatea__________
_______________repartizat n centrul universitar ________________________.
V

rog

s-mi

aprobai

___________________________,

din

___________________________

detaarea
centrul

centrul

pe

universitar
universitar

perioada

de

pregtire

de

pregtire

_______________________________ .
Solicit aceast detaare din urmtoarele motive:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Telefon de contact _________________________________________________
Anexez la prezenta cerere: - copie aprobare ndrumtor de stagiu.

Data_____________

Semntur solicitant ____________________