UNIVERSITATEA SPIRU HARET

FACULTATEA (organizatoare)_______________________________

FI DE NSCRIERE
La examenul de licen/diplom
Sesiunea___________20___

1. Numele i prenumele:__________________________________________________________________
2. Data i locul naterii: ziua___, luna___________, anul______, localitatea,________________________
Judeul____________, CNP______________________________.
3. Prenumele prinilor: tata_____________________________, mama___________________________ .
4. Domiciliu stabil: localitatea_____________________________________________________________,
judeul/sectorul_____________, strada_________________________, nr. _____, blocul___, scara____,
etajul_____, apartamentul____.
5. Ocupaia:__________________________
6. Locul de munc:_______________________________, telefon_________________________________
7. Numr de telefon:___________________
8. Email:____________________________
9. Date privind studiile:
a) Facultatea absolvit ________________________________________________________________
b) Programul de studii absolvit__________________________________________________________
c) Forma de nvmnt:_____________
d) Durata studiilor__________________
e) Anul studiilor___________________
10. Titlul lucrrii de licen/diplom________________________________________________________
11. Coordonator tiinific__________________________________________________________________
12. Numrul chitanei de plat a taxei de licen/diplom_________________________________________
13. Numrul chitanei pentru indrumarea i conducerea lucrrii de licen/diplom_____________________

Data,

Semntura,