APPLICATION CONCERNING THE RECOGNITION OF A FOREIGN QUALIFICATION
201
.
.
(month)
I hereby apply for the recognition of my qualification acquired abroad. I hereby produce the
following data required for an objective assessment of my qualification:
1. PERSONAL DATA OF THE QUALIFICATION HOLDER
Name, last name
Previous name, last name (if changed)
Gender
female
male
Date of birth (year-month-day)
Citizenship
Republic of Lithuania
Other
_________________________________
E-mail:
Tel.
Residence address (street, house No.,
apartment No., region, city, State)
2. THE QUALIFICATION REQUESTED TO BE RECOGNISED
Name of the qualification
(in the original language, Latin alphabet)
Diploma issue date
Name of the institution which granted the
doctoral degree in science (art) (in the
original language, Latin alphabet)
The State in which the qualification was
acquired
Actual location of the education (studies)
institution (indicate the address)
daytime
Study form:
evening
distance
full-time
other_____________
correspondence
external studies
part-time
Duration of the studies year, from -to)
Title of the thesis (in the original and in
the Lithuanian languages)
Science (art) research field closest to the
subject matter of the thesis
Thesis defending date
Have you previously applied concerning
an assessment / recognition of your
qualification in Lithuania?
no
yes_______________________________________________
date and the institution (enter)
Notes
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3. PURPOSE OF THE RECOGNITION
Work
Other (enter)
4. PREVIOUS EDUCATION (acquired prior to the qualification requested to be recognised, to be listed starting
with the higher education)
Name of the
qualification
(in the original
language, Latin
alphabet)
Duration of
the education
(studies)
(year - from - to)
Name of the
education (studies)
institution
(in the original
language, Latin
alphabet)
Address of the
education
(studies)
institution
Education
(studies) form
Notes
5. DATA ON THE RESEARCH AND PEDAGOGICAL ACTIVITIES (not more than 10 past years)
Date of the
recruitment
Date of the
dismissal
Name of the workplace
Position
5. SUBMITTED DOCUMENTS
A document certifying the acquired doctoral degree in science (art), or its certified copy
Supplement to the diploma of doctor in science (art) (if any), or its certified copy
Personal identity document or its certified copy
List of research publications (printed or electronic version)
Doctoral thesis (printed or electronic version)
Notes
6. DATA ABOUT THE AUTHORISED PERSON (to be filled in in case the qualification holder is represented by a
person authorised by the applicant to perform the actions related to the recognition of the qualifications)
Name, last name
E-mail
Tel.
Residence address (street, house No.,
apartment No., region, city, State)
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7. REPRESENTATION
APPLICANT‘S SIGNATURE
Patvirtinu, kad:
šioje paraiškoje pateikti duomenys yra teisingi,
pateikti dokumentai yra autentiški ir išduoti man.
I hereby confirm that:
the information provided in this application is true
and the submitted documentation is authentic and
issued to me.
I understand that provision of false information
and/or submission of fraudulent documentation will
influence the outcome of the recognition of my
qualification and may be reported to the relevant
competent authorities.
žinau, kad neteisingų duomenų ir (ar) neautentiškų
dokumentų pateikimas turės įtakos priimant
sprendimą dėl kvalifikacijos akademinio pripažinimo
ir, kad apie tokių duomenų ar dokumentų pateikimą
gali būti pranešta kompetentingoms institucijoms.
/signature/
/name, last name of the applicant/
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