Application Form for Final Essay (Summary) Registration for High School Graduates

To the Head of the Educational Organization

Application for a Current-Year Graduate

I,

Last name

First name

Date of birth:
d
d
.
m
m
.
y
y

Middle name

Identity document: ____________________________

Series

Number

Gender:

male

female

I request to be registered for participation in the final

essay

            summary

in order to obtain admission to the state final certification under the general secondary education programs.

Consent to the processing of personal data is attached.
*I request the creation of conditions for writing the final essay (summary) considering my health condition, as confirmed by (to be filled out by participants with disabilities, children with disabilities, and persons with disabilities):

(specify necessary conditions)
Disability certificate

Recommendations of the Psychological-Medical-Pedagogical Commission (PMPC)

Applicant’s signature    /_________________ (Full name)

«__» _____________ 20_

Contact phone number

(

)