Doamn Director,

Subsemnatul (a) ______________________________________________, domiciliat n localitatea:

_____________ judeul: _____________ strada: ____________ nr. ____ bloc _____ scara _____ etaj _____
apartament ____, n calitate de (printe, tutore, susintor legal) v solicit nscrierea elevului/elevei
_____________________________________________, n clasa a _____- a , n anul colar 2013-2014,
profil ___________ specializarea __________________________________________.
DATE DESPRE ELEV:
Numele:_____________________________________

Lb. mod. avansat:________________

Prenumele: ________________________________

Lb. mod. nceptoare: ______________

Data i locul naterii: ___________________________________________ Religia: ______________

Codul Numeric Personal:

I_I_I_I_I_I_I_I_I_I_I_I_I_I

Nr. telefon mobil: __________________

Domiciliul: (localitate, strad/nr.bloc, sc.ap.)_____________________________________________________

Naionalitatea: ______________

Cetenia: ______________

e-mail ___________________

B.I./C.I. Seria ____Nr. ___________ emis de _____________ la data de ________________

DATE DESPRE PRINI:
TATA
Numele i prenumele: _____________________________________________________
Data i locul naterii: ________________________________ CNP I_I_I_I_I_I_I_I_I_I_I_I_I_I
Domiciliul: (localitate, strad / nr. bloc, sc.ap.)____________________________________________________
Telefon: ___________ Telefon mobil: _______________

Naionalitate: _______________________

Loc de munc: Denumirea unitii, adres ___________________________________________________

Telefon: _____________ Profesia: _______________ Funcia: _____________

e-mail __________

B.I./C.I. Seria ____ Nr. ___________ emis de _____________ la data de ________________

MAMA
Numele i prenumele: _____________________________________________________
Data i locul naterii: ________________________________ CNP I_I_I_I_I_I_I_I_I_I_I_I_I_I
Domiciliul: (localitate, strad/nr.bloc, sc.ap.)_______________________
Telefon: ___________ Telefon mobil: _______________

Naionalitate: _____________________

Loc de munc: Denumirea unitii, adres _____________________________

e-mail ______________

Telefon: _____________ Profesia: _______________ Funcia: _____________

B.I./C.I. Seria ____ Nr. ___________ emis de _____________ la data de ________________

Voi locui la (gazd, internat, prini)__________________________

Data: ______________

Semntur: _______________
(printe/tutore/susintor legal)

Doamnei Director a Colegiului Naional Mihai Eminescu - Botoani