Ministerul Educaţiei

Universitatea „Lucian Blaga” din Sibiu

Institutul de Organizare a Studiilor Doctorale şi

Postdoctorale

Annex 12.2B
„Lucian Blaga” University of Sibiu
Office of Doctoral and Postdoctoral Studies and Habilitation
APPLICATION FORM
For the entrance exam in the program of doctoral studies
September 2024

1. Personal data of the candidate:

Identification number:
_________________________________________
Surname at birth (from the birth certificate):
__________________________________________
Surname after marriage (if necessary):
__________________________________________
Name:
___________________________________________
Father’s name:
____________________________________________

Date and place of birth:

Year ___________, Month ____________, Day _______________
Place ____________________________________________
County _______________________________________________
ID / Passport: series ________, number _____________, issued by ____________________________

Residence (as in the ID): ______________________________________________________________

___________________________________________________________________________________

Home of correspondence: ____________________________________________________________

____________________________________________________________________________________

Phone number and e-mail address și adresă de e-mail:

_____________________________________________________________

Bd. Victoriei, Nr. 10 Tel.: +40 269 23.62.07., int. 110

550024 Sibiu, România Fax: +40 269 23.62.07
doctorate.ulbsibiu.ro E-mail: dep.doctorate@ulbsibiu.ro
 Ministerul Educaţiei
Universitatea „Lucian Blaga” din Sibiu

Institutul de Organizare a Studiilor Doctorale şi

Postdoctorale
Signature,

Place of work _________________________________________

Occupation ___________________________________________
Citizenship __________________________________________
Other citizenships ______________________________________
II. STUDIES
Bachelor degree (University and year of graduation):
1. _____________________________________________________________________
2. _____________________________________________________________________
Master degree (University and year of graduation):
1. __________________________________________________________________________
2. ___________________________________________________________________________
I have benefited or am currently benefiting from budget funding for a doctoral program in Romania:
 YES
Specify Institution / University and research field:
__________________________________________________________
 NO

III. Foreign language proficiency:

_______________________________________________________________________
IV SPECIAL SOCIAL STATUS:

 Age under 26 years and half-orphan

 Age under 26 and orphan

 Raised in orphanage

 Originated from monoparental family

 Candidate who falls into the category of persons with disabilities, based on documents.

ETHNICITY: _______________________________
Bd. Victoriei, Nr. 10 Tel.: +40 269 23.62.07., int. 110
550024 Sibiu, România Fax: +40 269 23.62.07
doctorate.ulbsibiu.ro E-mail: dep.doctorate@ulbsibiu.ro
 Ministerul Educaţiei
Universitatea „Lucian Blaga” din Sibiu

Institutul de Organizare a Studiilor Doctorale şi

Postdoctorale

Signature,

V. DECLARATION

1. The undersigned ___________________________, identified with the ID/Passport series

_______, no ________________, hereby declare on my own responsibility the following:
 I have not been enrolled in doctorate studies in Romania until now;

 I was enrolled in doctoral studies in Romania during the period __________________,

University ___________________________, Faculty _________________________,
research field ___________________________, form of finance:

 Fee paying

 No fee

 Scholarship

2. I hereby declare that I understand the meaning of all the required data and certify the accuracy of my
claims. I undertake to notify the Office of Doctoral and Postdoctoral Studies and Habilitation of any changes
in the declared data.

Date, Signature,

Bd. Victoriei, Nr. 10 Tel.: +40 269 23.62.07., int. 110

550024 Sibiu, România Fax: +40 269 23.62.07
doctorate.ulbsibiu.ro E-mail: dep.doctorate@ulbsibiu.ro
 Ministerul Educaţiei
Universitatea „Lucian Blaga” din Sibiu

Institutul de Organizare a Studiilor Doctorale şi

Postdoctorale
Verified within the Office of Doctoral and Postdoctoral Studies and Habilitation by:

Date, Signature,

Bd. Victoriei, Nr. 10 Tel.: +40 269 23.62.07., int. 110

550024 Sibiu, România Fax: +40 269 23.62.07
doctorate.ulbsibiu.ro E-mail: dep.doctorate@ulbsibiu.ro