NOTE: Toate rubricile sunt obligatorii cererea trebuie completată în 2 exemplare și însoțită de documentele menționate în [629815]

ANEXA 2
NOTE: Toate rubricile sunt obligatorii; cererea trebuie completată în 2 exemplare și însoțită de documentele menționate în
Secțiunea V. All the fields are mandatory, must be completed in 2 copies and have to be accompanied by the documents
mentioned in Se ction V, orelse your request will not be processed. Tous les champs sont obligatoires, doivent être complétés en 2
exemplaires et doivent être accompagnés par les documents mentionnés à la Section V, sinon votre sollicitation ne sera pas
analysée. Nr. Ref……………..
MINISTERUL EDUCAȚIEI ȘI CERCETĂRII
MINISTRY OF EDUCATION AND RESEARCH
MINISTÈRE DE L’ÉDUCATION ET DE LA RECHERCHE

DIRECȚIA GENERALĂ RELAȚII INTERNAȚIONALE ȘI AFACERI EUROPENE
GENERAL DIRECTION FOR INTERNATIONAL RELATIONS AND EUROPEAN AFFAIRS
DIRECTION GÉNÉRALE DES RELATIONS INTERNATIONALES ET DES AFFAIRES EUROPÉENNES

28-30 G -ral Berthelot Street/12 Spiru Haret Street,010168 Bucharest
Tel. (+4021) 4056200; 4056300

CERERE PENTR U ELIBERAREA SCRISORII DE ACCEPTARE LA STUDII
APPLICATION FOR THE ISSUANCE OF LETTER OF ACCEPTANCE TO STUDIES
DEMANDE D’APPLICATION POUR LA LETTRE D’ACCEPTATION AUX ÉTUDES
( Se completează cu majuscule/ to be filled in with capital letters/ à completer en majuscules)

1. NUMELE_______________________________________________PRENUMELE__________________________________________________________
(SURNAME/NOMS) (GIVEN NAMES/PRENOMS)

2. NUMELE PURTATE ANTERIOR__________________________________________________________________________________________________
(PREVIOUS SURNAMES/ NOMS ANTERIEURS)

3. LOCUL ȘI DATA NAȘTERII Țara__________________________Localitatea_______________________Data
(DATE AND PLACE OF BIRTH/ (COUNTRY/PAYS) (PLACE/LIEU) (DATE/DATE) Z Z L L A A A A
DATE ET LIEU DE NAISSANCE ( D D M M Y Y Y
Y )

4. PRENUMELE PĂRINȚILOR_____________________________________________________________________________ _________________________
(PARENTS GIVEN NAMES/PRENOMS DES PARENTS)

5. SEXUL (SEX/SEXE) : M F

6. STAREA CIVILĂ : CĂSĂTORIT(Ă) NECĂSĂTO RIT(Ă) DIVORȚAT (Ă) VĂDUV(Ă)
(CIVIL STATUS/ETAT CIVIL) (MARRIED/MARIE) (SINGLE/CELIBATAIRE) (DIVORCED/DIVORCE)
(WIDOWER)/VEUV(VEUFE))

7. CETĂȚENIA (CETĂȚENIILE) ACTUALE_________________________________CETĂȚEN II ANTERIOARE__________________________________
(ACTUAL CITIZENSHIP(S)NATIONALITE(S) ACTUELE(S)) (PREVIOUS CITIZENSHIPS/NATIONALITES ANTERIEURES)

8. DOCUMENT DE CĂLĂTORIE : TIPUL______________________________SERIE_________________________ NR._______________________
(TRAVEL DOCUMENT/DOCUMENT DE VOYAGE) (TYPE/TYPE) (SE RIE/SÉRIE) (NO/NO)

ELIBERAT DE ȚARA:__________________________ LA DATA VALABILITATE_________________
(COUNTRY ISSUED BY/ EMIS PAR PAYS) (DATE OF ISSUE/A) Z Z L L A A A A (VALIDITY/EXPIRANT LE)

9. DOMICILIUL PERMANENT ACTUAL : ȚARA ______ _________________________ LOCALITATEA_________________________________________
(PERMANENT RESIDENCE/DOMICILE (COUNTRY/PAYS) (PLACE/LOCALITE)
PERMANENT ACTUEL)

10. PROFESIA_____ ___________________________________________LOCUL DE MUNCĂ____________________________________________________
(PROFESSION/PROFESSION) ( WORK PLACE/ LIEU DE T RAVAIL)

11. ADRESA COMPLETĂ UNDE POATE FI TRIMISĂ SCRISOAREA DE ACCEPTARE
(THE COMPLETE ADDRESS WHERE THE LETTER OF ACCEPTANCE CAN BE SENT TO YOU / L'ADRESSE COMPLÈTE OÙ ON PEUT ENVOYER LA LETTRE D`A CCEPTATION)

____________________________________________________________________________________________________________________

12. EMAIL/ COURRIEL:
_____________________________________________________________________________________________________________________ _____________

13. MOTIVAȚIA DEPLASĂRII ÎN ROMÂNIA (PURPOSE OF VISIT/BUT DE SEJOUR)

STUDII (STUDIES / ÉTUDES)

I. Previous education / Études précédentes (Fill in all columns which are applicable to you/ Remplez toutes les
colonnes qui vous concernent)
Certificate issued/
Certificat reçu Country/
Pays Name of School/ Nom du Lycée/université Year of admission/ Year
of graduation
Année d̕admission/Année
d̕obtention du diplôme

II. Studies applied for in Romania / Option d’études en Roumanie
Studies applied in Romania

Option d’études en
Roumanie Branch
/Speciality

Domaine
/Spécialité High School/
University

Lycée / Université Language of
instruction

Langue
d’enseignement I apply for the Romanian
language course (For YES you
have to mention the University)

Je désire suivre le cours
préparatoire de langue
Roumaine (Pour OUI il faut
mentionner l’Université)
YES / OUI NO / NON
Secondary, in the grade
Pré-universitaire, classe
Undergraduate
Universitaire
Master

Postgraduate medical
education/ Études médicales
postuniversitaires
Ph.D.
Doctorat

III. Proficiency in other languages (please, fill in as appropriate: excellent, good, poor)
Langues connues (rempli: excellent, bonne, faible)
Language
Langue Writing
Écrit Speaking
Parlée Institution that issued the certificate
Institution qui a émis le certificat
Romanian

IV. Statement of the applicant / Déclaration du solliciteur
I oblige myself to observe the laws in force in Romania, the school and university rules, regulations and norms, as well as
those for social life. / Je suis obligé de respecter les lois en vigueur en Roumanie, les normes et les réglementations des é coles e t
des universités, ainsi que les règles de cohabitation sociale.
I have taken note of the fact that school fees may change during the years of study and must be paid, in free currency, in
advance for a period of at least 9 months for full time courses and at least 3 months for part time courses. / J’ai pris note que la
valeur des taxes d’études peut être changée pendant l’année d’études et qu’il faut les payer, en devise étrangère, 9 mois en avance
pour les cours complets et 3 mois en avance pour les cours partiels.
I am aware that any untrue information will lead to my disqualification. / Je comprends et j’accepte que toute information
incorrecte ou fausse, toute omission vont entraîner ma disqualification.
V. Annex (authenticated copies and translations o f the documents, in an internationally wide -spread language)
Annexes (photocopies et traductions légalisées des documents, dans une langue de circulation internationale)
1. The certificate of studies / Les certificats des études.
2. The birth certific ate / L’acte de naissance.
3. Passport / Passeport
4. Medical certificate / Certificat médical.
5. The list of results of the completed study years (Academic Transcripts) for postgraduate studies applicants and for those
wishing to continue studies begun in other countries / La liste complète des résultats des études pour chaque année, pour les
solliciteurs des études postuniversitaires et pour les étudiants qui désirent se transférer d’un autre pays.

On my arrival in Romania I should submit the original documents.
À mon arrivée en Roumanie je vais présenter tous les documents en original.
Date ______________________________ Signature ________________________________