Coordonator program

rezideniat

DE ACORD

CERERE DETAARE
PLECARE din Centrul Universitar .

Subsemnatul(a) ......................................................................................................................

cod rezident ..... rezident / specialist n specialitatea

................................................................................................................................................
(n care desfoar a 2-a specialitate cu tax)

n centrul universitar .................... angajat la .............................................................

................................................................................................................................................

v rog s binevoii a-mi aproba efectuarea stagiului ..............................................................

................................................................................................................................................

din curriculum de pregtire n specialitate, n perioada ..........................................................

n unitatea sanitar ...............................................................................................................

secia / secia clinic ............................................................................................................

Data Semntura

.. .

Domnului prof. univ. / conf. univ. / ef lucr. dr. .........................................................................