To the Rector of the FSBEI HE «Pitirim Sorokin Syktyvkar State University»

Federal State Budget Educational Institution of Higher Education «Pitirim Sorokin Syktyvkar State University»

License for the right to provide educational services Series - № 1415 on 29.04.2015 by Federal Service for Supervision in Education and Science

Certificate of State Accreditation Series - № 3471 on 30.12.2020 by Federal Service for Supervision in Education and Science. Certificate valid until 30.12.2026

From

To the Rector of the FSBEI HE «Pitirim Sorokin Syktyvkar State University»

Sotnikova O. A.

Last Name

Nationality

Name

Identity document (passport)

Patronymic

Date of birth

series

№

Place of birth

Issued/date of issue:

Permanent address: ______________________________________________________________

E-mail __________________________________________________________________

Phone number: home -_____________________ mobile -_________________________________________

Compulsory pension insurance certificate number (СНИЛС) (if any)

APPLICATION FOR CONSENT TO ENROLMENT

I consent to my admission on the following conditions and grounds of admission:

Speciality

Form of study*

Foundation of admission**

Admission Category

Type of education

Consent to enrolment

General medicine

Full-time

Contractual basis (ПО/CB)

Specialitet

* Specify the form of study for each specialty:

Extramural Study, Full-time, Part-time, External

** Specify foundation of admission for each specialty:

State-funded (Б/B), Contractual basis (ПО/CB), Entrance Quotum (ЦП/EQ)

I confirm the absence of valid (unexplained) applications to enroll in higher education programmes at a given level in the field within the admission targets, including those submitted to other organizations.

"_____"

____________

2021.

(Signature)

I pledge during my first year of study:

- To provide the university with the original certificate/diploma (when admitted to the university within the admission targets, including quota places);

- To undergo compulsory preliminary medical examinations (check-ups) in the course of training in the specialties and study directions included in the list of specialties and study courses; on admission to a course for which the applicants undergo mandatory prior medical examinations (check-ups).

"_____"

___________

(Signature)