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Warsaw, …………………………

………………………………………………….
(Name and Surname)

………………………………………………….
(Semester, Academic Year)

………………………………………………….
(Student ID card numer)

………………………………………………….
(Field of study)

………………………………………………….
(specialization of studies)

To The Dean of ………………………………….

Request

I kindly ask you to agree to a conditional entry to …………… Year ………..………. Semester
from the subject
……………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………….
Please consider my request positively

…………………………………
(Student’s signature)

Dean’s decision:

……………………………………………
(Dean’s signature and stamp)

Warsaw, ……………………………

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