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<title>Name, Vorname</title>
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<h1><span style='font-size:11.0pt;font-weight:normal'>Matrikelnr.: 081579</span></h1>
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<p class=MsoNormal><span style='font-size:7.0pt;font-family:Arial'>Alexander
Schwarz<72> </span><span style='font-size:7.0pt;font-family:Wingdings'>&#159;</span><span
style='font-size:7.0pt;font-family:Arial'><EFBFBD> Innsbrucker Str. 53<35> </span><span
style='font-size:7.0pt;font-family:Wingdings'>&#159;</span><span
style='font-size:7.0pt;font-family:Arial'><EFBFBD> 70329 Stuttgart</span></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'>FH-Ludwigsburg</span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'>Zulassungsamt</span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'>Reuteallee
36</span></p>
<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'>71364
Ludwigsburg</span></p>
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<h1>&nbsp;</h1>
<h1>Praktische Ausbildung im Vorbereitungsdienst</h1>
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<h1>Antrag auf Zuweisung zu den Ausbildungsstellen</h1>
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<p class=MsoNormal><b><span style='font-family:Arial'>Ausbildungsstelle</span></b></p>
<p class=MsoNormal><b><span style='font-family:Arial'>Anschrift</span></b></p>
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<p class=MsoNormal><b><span style='font-family:Arial'>Ausbildungsinhalt</span></b></p>
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<p class=MsoNormal><b><span style='font-family:Arial'>Sachbereich</span></b></p>
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<h1>Pers<EFBFBD>nliche Erkl<6B>rung</h1>
<p class=MsoNormal style='margin-left:18.0pt;text-indent:-18.0pt'><b><span
style='font-family:Arial'>1. <20> Die Hinweise der Fachhochschule Ludwigsburg zur
praktischen Ausbildung gem. <20> 17 Abs. 1 AprOVw gD (Praxisjahr) habe ich zur
Kenntnis genommen.</span></b></p>
<p class=MsoNormal style='margin-left:18.0pt;text-indent:-18.0pt'><b><span
style='font-family:Arial'>2.<2E><> F<>r die Zeit einer Zuweisung au<61>erhalb
Baden-W<>rttembergs verzichte ich auf die Erstattung etwaiger Reisekosten sowie
auf die Verg<72>tung von Umzugskosten und Trennungsgeld.</span></b></p>
<p class=MsoNormal style='margin-left:18.0pt;text-indent:-18.0pt'><b><span
style='font-family:Arial'>3.<2E><> Das Einverst<73>ndnis aller o.a. Ausbildungsstellen
liegt mir vor.</span></b></p>
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style='font-family:Arial'>&nbsp;</span></p>
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style='font-family:Arial'>&nbsp;</span></p>
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<table cellpadding=0 cellspacing=0 align=left>
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src="Praxisstellen-Dateien/image001.gif"></td>
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</tr>
<tr>
<td height=2></td>
<td colspan=2 align=left valign=top><img width=25 height=2
src="Praxisstellen-Dateien/image002.gif"></td>
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<td height=234></td>
</tr>
<tr>
<td height=2></td>
<td align=left valign=top><img width=12 height=2
src="Praxisstellen-Dateien/image001.gif"></td>
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<span style='font-family:Arial'>&nbsp;</span></p>
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<p class=MsoNormal style='margin-left:35.25pt;text-indent:-35.25pt'><span
style='font-family:Arial'>Datum, Unterschrift</span></p>
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