The Dean’s Office of the Faculty of Medicine,

Masaryk University in Brno


Application for Permission to Defend Doctoral Thesis


Surname, first/middle name, and title:



Date and place of birth:



Nationality:





Place of work:



Position:



University degree certificate (faculty from which (s)he graduated):



Date of State Doctoral Examination:



Dates of language exams:



Title of doctoral thesis:


Title of thesis in English:


Key words



                                                                                    Area of study:








                                                                                  ……………………………………………


                                                                 Signature and address of applicant

                                                            Date:



Please enclose the following documents:

1.      A legally attested copy of your university degree certificate;

2.      A curriculum vitae;

3.      A certificate of the examinations passed (protocols; in case of intermediate examinations
and required courses enclose copies of respective entries in your study record book);

4.      4 copies of your doctoral thesis and 20 copies of summary booklets provided with an
abstract in English;

5.      A list of all of your publications (in the summary booklet the Ph.D. student gives only
original publications which (s)he published in the course of preparation of his or her thesis –
(s)he is expected to have published at least two publications in full extent);

6.      A supervisor’s comment on your work and activity during your Ph.D. study and his or her
opinion concerning defence of your thesis;

7.      An opinion of head of the training institution concerning the content and quality of your
thesis with the conclusion to either start or not start its defence;

8.      A certificate issued by the FM MU Central Library stating that you have settled all your
obligations (return of all loans and settlement of possible agreed penalty for delay)