Title: Wrocław , dnia 2023-06-28
Author: bardowski
Last saved by: Marek Krupa
Company: Bin

Politechnika Wrocławska

Wrocław, date ………………
Name and surname: 
Student ID: 
Faculty: Information and Communication Technology
Field of study: 
Specialty:  
Current study stage: 
Level of studies: 

Dziekan 
Wydział Informatyki i Telekomunikacji
Politechniki Wrocławskiej

Concerns: retake of the stage of study

(specify study stage)

I kindly ask for possibility of the retake of the stage of study ………….. in the semester:
 summer / winter* ……………….

Justification: 

.........................................
	Student signature

Subjects to be realized:

•	Including overdue:
Subject’s code | Subject’s name | Semester according to plan of study | ECTS

ECTS sum:

•	Including subjects realized in advance:
Subject’s code | Subject’s name | Semester according to plan of study | ECTS

ECTS sum:
.........................................
	Student’s signature

WYRAŻAM ZGODĘ / BRAK ZGODY

Decyzja Prodziekana*:     		

Uzasadnienie w przypadku braku zgody:

Application shall be fulfilled electronically using edition of the document 
* cross-out inappropriate