To the attention of Prof. RNDr. Luděk Bláha, Ph.D.,

                                  Vice-Dean for science, research, foreign affairs and doctoral
                                              studies


                                       General request form


Content and justification of the request:


Applicant:

Name and surname:

Study programme:

Field of study/Study plan:

Contact address:




Date:


      applicant´s signature


Supervisor´s statement:


Name and surname:


              Date and signature


Head of doctoral committee´s statement:

(if applicable, i.e. if the doctoral committee is appointed)


Name and surname:


              Date and signature

Head of doctoral board´s statement:


Name and surname:


              Date and signature