ADMITERE în învățământul liceal/profesional și dual de stat pentru anul școlar 2019 – 2020

CERERE DE ÎNSCRIERE Etapa de situații speciale 19 iulie 2019 - 22 iulie 2019

Nr. înreg. …………… / /….07.2019

11.. DDaattee pprriivviinndd ssoolliicciittaannttuull ((ppăărriinntteellee // ttuuttoorreellee lleeggaall iinnssttiittuuiitt))

NNuummeellee ………………………………………………………………………………………………………………......………………………………………...………………...... PPrreennuummeellee ………………………………………………………... ...………………………………………………......………………......………...………………………………………………………

TTeelleeffoonn:: ………………………………………………………………………………………………………………………………………………………………... EEmmaaiill:: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

CCaalliittaatteeaa ssoolliicciittaannttuulluuii:: ⃝ ppăărriinnttee ⃝⃝⃝ ttuuttoorree lleeggaall iinnssttiittuuttiitt

22.. DDaattee pprriivviinndd eelleevvuull

NNuummeellee ………………………………………………………………………………………………………......………………………………………...………………...... PPrreennuummeellee ………………………………………......………………………………………………………………......………………......………...………………………………………………………………

CCNNPP || || || || || || || || || || || || || ||

⃝⃝⃝ DDoommiicciilliiuull // ⃝ RReeșșeeddiinnțțăă:: SSttrr.. ………………………………………………...... ... ... ...………...………………………………………......……………… NNrr.. ………...……… BBll.. ………...……… SScc.. ………...……… EEtt.. ………...……… AApp.. ………......………

CCoodd ppoossttaall:: ……………………………………………………………………………… LLooccaalliittaattee:: ………………………………………………………………………......………………………...... JJuuddeețț // SSeeccttoorr ………………………... ...………………………………………………………………………………………...

TTeelleeffoonn:: ………………………………………………………………………………………………………………………………………………………………... EEmmaaiill:: ………………………………………………………………………………………………………………………………………………………………………………………………... ...………………………………………………...

33.. DDaattee pprriivviinndd situația școlară aa eelleevvuulluuii

UUnniittaatteeaa ddee pprroovveenniieennțțăă ……………………………………………………………………………………………………………………………………………………………………………………………………… JJuuddeețț // SSeeccttoorr ………………………………………………………………………………………………......

AAnnuull aabbssoollvviirriiii ccllaasseeii aa VVIIIIII--aa ………......………………... MMeeddiiaa llaa EEvvaalluuaarreeaa NNaațțiioonnaallăă ………………………………... MMeeddiiaa ccllaasseelloorr VV––VVIIIIII ………………………………...

RReeppaarrttiizzaatt în aannuull 22001199 llaa ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

DDoossaarruull ddeeppuuss îînn ppeerriiooaaddaa 1155 ––– 1188 iiuulliiee 22001199 llaa uunniittaatteeaa uunnddee aa ffoosstt rreeppaarrttiizzaatt -- ⃝⃝⃝ DDAA ⃝⃝⃝ NNUU

MMeeddiiaa ddee aaddmmiitteerree ………………......………………………

44.. DDaattee pprriivviinndd ssiittuuaațțiiaa ssppeecciiaallăă

⃝⃝ ssiittuuaațțiiee mmeeddiiccaallăă ssppeecciiaallăă ⃝⃝ sscchhiimmbb îînnttrree eelleevvii ⃝⃝ ccaannddiiddaattii ggeemmeennii ⃝⃝ rreeddiissttrriibbuuiirree ppeennttrruu aapprrooppiieerree ddee ddoommiicciilliiuu ⃝⃝ eerroorrii ddee ttrraannssccrriieerree ggrreeșșiittăă îînn bbaazzaa ddee ddaattee ⃝⃝ nnuu aa ddeeppuuss ddoossaarruull îînn ppeerriiooaaddaa 1155 –– 1188 iiuulliiee 22001199 ⃝⃝ nnuu aa ppaarrttiicciippaatt llaa rreeppaarrttiizzaarreeaa ccoommppuutteerriizzaattăă ⃝⃝ aa ppaarrttiicciippaatt llaa rreeppaarrttiizzaarreeaa ccoommppuutteerriizzaattăă,, ddaarr nnuu aa ffoosstt rreeppaarrttiizzaatt

ADMITERE în învățământul liceal/profesional și dual de stat pentru anul școlar 2019 – 2020

55.. DDaattee pprriivviinndd uunniittăățțiillee ddee îînnvvăățțăămmâânntt lliicceeaall ssoolliicciittaattee SSoolliicciitt îînnssccrriieerreeaa,, îînn ffuunnccțțiiee ddee nnuummăărruull ddee llooccuurrii ddiissppoonniibbiillee,, llaa uunnaa ddiinn uunniittăățțiillee ddee îînnvvăățțăămmâânntt lliicceeaall îînn uurrmmăăttooaarreeaa oorrddiinnee pprreecciizzaattăă:: (( ssee ttrreeccee ddeennuummiirreeaa lliicceeuulluuii şşii ccoodduull rreessppeeccttiivv ))

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AAnneexxeezz pprreezzeenntteeii uurrmmăăttooaarreellee ddooccuummeennttee::

⃝⃝⃝ CCooppiiaa aaccttuulluuii ddee iiddeennttiittaattee aall eelleevvuulluuii ((cceerrttiiffiiccaatt ddee nnaașștteerree // ccaarrttee ddee iiddeennttiittaattee))

⃝⃝⃝ CCeerrttiiffiiccaatt mmeeddiiccaall,, eelliibbeerraatt ddee DDiirreeccţţiiaa ddee SSăănnăăttaattee PPuubblliiccăă

⃝⃝⃝ AAccoorrdduull ssccrriiss aall ppăărriinntteelluuii//ttuuttoorreelluuii eelleevvuulluuii ccuu ccaarree ssee ddoorreeșșttee sscchhiimmbbuull ddee lloocc

⃝⃝⃝ CCooppiiaa aaccttuulluuii ddee iiddeennttiittaattee aa ((cceerrttiiffiiccaatt ddee nnaașștteerree // ccaarrttee ddee iiddeennttiittaattee)) a ffrraatteelluuii ggeeaammăănn

⃝⃝⃝ Copie aaddeevveerriinnțțăă ccuu mmeeddiiaa ddee aaddmmiitteerree

⃝⃝⃝ CCooppiiaa dduuppăă aanneexxaa llaa ffiișșaa ddee îînnssccrriieerree Sunt de acord ca datele personale din prezenta cerere să fie prelucrate în scopul înmatriculării copilului. Cunoscând prevederile Codului Penal privind falsul în declaraţii, declar pe propria răspundere şi sub sancţiunea nulităţii

înscrierii faptul că datele din prezenta cerere sunt reale.

DDaattaa ccoommpplleettăărriiii::__________________________________________________________________ SSeemmnnăăttuurraa::_______________________________________________________________