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Coordonator n specialitatea

modulului solicitat
DE ACORD

CERERE DETAARE
PRIMIRE n 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. .........................................................................

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