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