Course modification form for students

Name and surname *

Date of birth *

E-mail *

Faculty *

Field of studies *

Semester *

Academic year *

Form of modification *

Subject code *

Subject name *

Specifying the form of modification

Write ALL academic titles of your teachers
Look up teachers in USERMAP ČVUT, eventually on the departmen’s website

Teacher 1 *

e-mail *

Teacher 2

e-mail

Teacher 3

e-mail

Teacher 4

e-mail

Teacher 5

e-mail

Select an authorized worker to send the form to her. (If you do NOT know, leave UNCHECKED):

Mgr. Barbora Čalkovská
Autism spectrum disorders, movement disorders, chronic disease

Mgr. Jana Bertlová
Hearing impairment, impaired communication ability, specific learning disabilities

Mgr. Martina Jančová
Mental illness

Mgr. Barbora Marešová
Visual impairment, specific learning disabilities

Mgr. Jana Pechancová
Specific learning disabilities, Attention-Deficit/Hyperactivity Disorder (ADD/ADHD)

* Marked fields are required