Sunteți pe pagina 1din 1

Anexa 1

UNIVERSITATEA DIN PITESTI


FACULTATEA DE STIINTE ALE EDUCATIEI, STIINTE SOCIALE SI PSIHOLOGIE

CERERE DE INSCRIERE
LA EXAMENUL DE___________________

I.Date personale ale candidatului


1. Date privind identitatea persoanei
Numele de nastere________________________________Numele de casatorie(daca este
cazul)___________________________________
Prenumele_______________________________CNP_______________________________
2. Sexul: O Feminin O Masculin
3. Data si locul nasterii:
Ziua/ luna/anul_________________/___________________/_______________________
Locul(localitatea, judet)___________________________/_______________________
4. Prenumele parintilor:
Tata__________________________________Mama________________________________
5. Sunt absolvent(a)promotia:______________/______________(anul inmatricularii/anul absolvirii)
6. Mentiuni privind scolarizarea:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
7. Forma de invatamant absolvita O IF O IFR O ID
O Fara taxa O Cu taxa
8. Solicit inscrierea la examenul de____________________, Sesiunea_________________anul__________
9. Lucrarea de______________________________ pe care o sustin are urmatorul titlu:
______________________________________________________________________________________________________
______________________________________________________________________________________________________
______________________________________________________________________________________________________
10. Coordonator stiintific:___________________________________________________________________________
11. Mentionez ca sustin examenul de _____________________( pentru prima oara, a doua oara
– dupa caz)_____________________________________
II. Documentele in original depuse la dosarul de inscriere:
1. Diploma de bacalaureat _________________________________________________________________________
2. Diploma de licienta / inginer ___________________________________________________________________
3. Alte documente ___________________________________________________________________________________

SEMNATURA, VERIFICAT,
Secretar facultate

_____________________________________________________________________________
( numele si prenumele, semnatura )

Am primit documentele in original depuse la dosarul de inscriere la examenul de


_________________________________________

_________________________________________ _________________________ _________________________


(Numele si prenumele) ( Semnatura ) ( Data )