Universitatea Tehnic "Gheorghe Asachi" din Iai

Aprobat,
Decan

DOMNULE DECAN
Subsemnatul, _____________________________________________________ ,
absolvent al ____________________________________________________________ ,
programul de studii universitare de master __________________________________
_______________________________________________________________________ ,
promoia _____________ , v rog s-mi aprobai nscrierea la examenul de disertaie
sesiunea _________________________________ .
Am mai susinut examenul de disertaie n anul _______________________ .
Am ntocmit lucrarea de disertaie cu titlul _____________________________
_______________________________________________________________________
_______________________________________________________________________
sub ndrumarea _________________________________________________________ .

Data: ________________

Semntura
____________________________

Viza ndrumtorului lucrrii

________________________
Media de colaritate (ECTS): ___________

Viz secretariat,

Domnului Decan al Facultii de ____________________________________________

Formular TUIASI.POB.27-F1, rev0