MINISTERUL EDUCAIEI NAIONALE

INSPECTORATUL COLAR JUDEEAN VASLUI

LICEUL "TEFAN PROCOPIU" VASLUI
STR. CASTANILOR, NR 3
TELEFON: 0235318122
FAX: 0235318614
Email : lspvaslui@yahoo.com
Web : http://lspvs.ro

PO.CEAC.04 - F 05

FORMULAR DE SESIZRI
pentru elevi

Data: ............................

Reclamant

Nume i prenume: .....

B.I./C.I.......................
Adres: ..
Numr de telefon: ..
Clasa: ...

Reclamat

Data incidentului:
Numele persoanei implicate n incident: .
Statutul persoanei implicate n incident: cadru didactic/elev/..
Detalii ale incidentului: ...............................................................................................................................
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Lista i semntura persoanelor care pot susine cele reclamate:

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Eventuale dovezi care pot susine cele reclamate:

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Semntura: