In doctoral study programme:

Applicant’s name, surname, title:
Department / workplace:
Study programme / branch:
Supervisor:
Supervisor-specialist:
Start date of study:
Current study form:    full-time  –  distant  –  part-time

Course of study and credits obtained:
Total number of credits obtained for compulsory courses		
Number of credits obtained for pedagogical activities		
Number of credits obtained for scientific, research and publication activities		
Number of credits for international internship		
Total number of credits		

I confirm the subjects were completed in accordance with the individual study plan.

Student signature: …………………………………………………………………………………………………………………

Supervisor signature: ……………………………………………………………………………………………………..……..

Chairman of the Branch Board signature: …………………………………………………………………………..