APPLICATION FOR: issuance of an additional copy of Wrocław University diploma and diploma supplement in English
Wrocław, on ………..
Name: ………
Place of residence: ..………
Contact (e-mail, tel.): ………..
Student number: ……….………
Program: undergraduate / graduate full time / weekend
………
Associate Dean of the Faculty of Letters, UWr
I hereby apply for the issuance of an additional copy of my Wrocław University undergraduate – graduate*
diploma and diploma supplement in English. I graduated in ………, in the field of: …..………
………..
The title of my diploma paper in English: .………….………..………
……….………..………
……….………..
I declare that:
- I have furnished a photograph( 1 print., 45x65 mm),
- I have paid the fee of PLN 40 for the issuance of an additional copy of Wrocław University diploma and diploma supplement in English.
*) delete as appropriate
………
(student signature)
