305 lines
12 KiB
HTML
Executable File
305 lines
12 KiB
HTML
Executable File
<html>
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<meta http-equiv=Content-Type content="text/html; charset=windows-1252">
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<meta name=Generator content="Microsoft Word 10 (filtered)">
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<title>Name, Vorname</title>
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</head>
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<body lang=DE>
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<div class=Section1>
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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:11.0pt'> </span></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'> </span></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'> </span></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'> </span></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'> </span></p>
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<table class=MsoTableGrid border=1 cellspacing=0 cellpadding=0
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style='border-collapse:collapse;border:none'>
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<tr>
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<td width=272 valign=top style='width:204.0pt;border:none;border-bottom:solid windowtext 1.0pt;
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padding:0cm 5.4pt 0cm 5.4pt'>
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<p class=MsoNormal><span style='font-size:7.0pt;font-family:Arial'>Alexander
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Schwarz </span><span style='font-size:7.0pt;font-family:Wingdings'>Ÿ</span><span
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style='font-size:7.0pt;font-family:Arial'> Innsbrucker Str. 53 </span><span
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style='font-size:7.0pt;font-family:Wingdings'>Ÿ</span><span
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style='font-size:7.0pt;font-family:Arial'> 70329 Stuttgart</span></p>
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</td>
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</tr>
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</table>
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<p class=MsoNormal style='text-autospace:none'><span style='font-size:11.0pt'> </span></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'>FH-Ludwigsburg</span></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'>Zulassungsamt</span></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'>Reuteallee
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36</span></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'>71364
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Ludwigsburg</span></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'> </span></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'> </span></p>
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<p class=MsoNormal><span style='font-size:11.0pt;font-family:Arial'> </span></p>
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<h1> </h1>
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<h1>Praktische Ausbildung im Vorbereitungsdienst</h1>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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<h1>Antrag auf Zuweisung zu den Ausbildungsstellen</h1>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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<table class=MsoNormalTable border=1 cellspacing=0 cellpadding=0 width=629
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style='width:471.5pt;border-collapse:collapse;border:none'>
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<tr>
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<td valign=top style='border:solid windowtext 1.0pt;padding:0cm 3.5pt 0cm 3.5pt'>
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<p class=MsoNormal style='margin-right:40.1pt'><b><span style='font-family:
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Arial'> </span></b></p>
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</td>
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<td width=152 valign=top style='width:113.85pt;border:solid windowtext 1.0pt;
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border-left:none;padding:0cm 3.5pt 0cm 3.5pt'>
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<p class=MsoNormal><b><span style='font-family:Arial'>Ausbildungsstelle</span></b></p>
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<p class=MsoNormal><b><span style='font-family:Arial'>Anschrift</span></b></p>
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</td>
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<td width=152 valign=top style='width:113.85pt;border:solid windowtext 1.0pt;
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border-left:none;padding:0cm 3.5pt 0cm 3.5pt'>
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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'> </span></b></p>
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</td>
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<td width=152 valign=top style='width:113.85pt;border:solid windowtext 1.0pt;
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border-left:none;padding:0cm 3.5pt 0cm 3.5pt'>
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<p class=MsoNormal><b><span style='font-family:Arial'>Sachbereich</span></b></p>
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</td>
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<td width=152 valign=top style='width:113.9pt;border:solid windowtext 1.0pt;
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border-left:none;padding:0cm 3.5pt 0cm 3.5pt'>
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<p class=MsoNormal><b><span style='font-family:Arial'>Zeitraum</span></b></p>
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</td>
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</tr>
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<tr style='height:2.0cm'>
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<td style='border:solid windowtext 1.0pt;border-top:none;padding:0cm 3.5pt 0cm 3.5pt;
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height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'>1</span></p>
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</td>
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<td width=152 style='width:113.85pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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<td width=152 style='width:113.85pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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<td width=152 style='width:113.85pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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<td width=152 style='width:113.9pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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</tr>
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<tr style='height:2.0cm'>
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<td style='border:solid windowtext 1.0pt;border-top:none;padding:0cm 3.5pt 0cm 3.5pt;
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height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'>2</span></p>
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</td>
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<td width=152 style='width:113.85pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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<td width=152 style='width:113.85pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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<td width=152 style='width:113.85pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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<td width=152 style='width:113.9pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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</tr>
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<tr style='height:2.0cm'>
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<td style='border:solid windowtext 1.0pt;border-top:none;padding:0cm 3.5pt 0cm 3.5pt;
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height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'>3</span></p>
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</td>
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<td width=152 style='width:113.85pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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<td width=152 style='width:113.85pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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<td width=152 style='width:113.85pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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<td width=152 style='width:113.9pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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</tr>
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<tr style='height:2.0cm'>
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<td style='border:solid windowtext 1.0pt;border-top:none;padding:0cm 3.5pt 0cm 3.5pt;
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height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'>4</span></p>
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</td>
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<td width=152 style='width:113.85pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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<td width=152 style='width:113.85pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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<td width=152 style='width:113.85pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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<td width=152 style='width:113.9pt;border-top:none;border-left:none;
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border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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padding:0cm 3.5pt 0cm 3.5pt;height:2.0cm'>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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</td>
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</tr>
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</table>
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<p class=MsoNormal><span style='font-family:Arial'> </span></p>
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<h1>Persönliche Erklärung</h1>
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<p class=MsoNormal style='margin-left:18.0pt;text-indent:-18.0pt'><b><span
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style='font-family:Arial'>1. Die Hinweise der Fachhochschule Ludwigsburg zur
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praktischen Ausbildung gem. § 17 Abs. 1 AprOVw gD (Praxisjahr) habe ich zur
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Kenntnis genommen.</span></b></p>
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<p class=MsoNormal style='margin-left:18.0pt;text-indent:-18.0pt'><b><span
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style='font-family:Arial'>2. Für die Zeit einer Zuweisung außerhalb
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Baden-Württembergs verzichte ich auf die Erstattung etwaiger Reisekosten sowie
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auf die Vergütung von Umzugskosten und Trennungsgeld.</span></b></p>
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<p class=MsoNormal style='margin-left:18.0pt;text-indent:-18.0pt'><b><span
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style='font-family:Arial'>3. Das Einverständnis aller o.a. Ausbildungsstellen
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liegt mir vor.</span></b></p>
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<p class=MsoNormal style='margin-left:18.0pt;text-indent:-18.0pt'><span
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style='font-family:Arial'> </span></p>
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<p class=MsoNormal style='margin-left:35.25pt;text-indent:-35.25pt'><span
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style='font-family:Arial'> </span></p>
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<p class=MsoNormal style='margin-left:35.25pt;text-indent:-35.25pt'>
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<table cellpadding=0 cellspacing=0 align=left>
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<tr>
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<td width=19 height=396></td>
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<td width=12></td>
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<td width=13></td>
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</tr>
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<tr>
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<td height=2></td>
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<td align=left valign=top><img width=12 height=2
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src="Praxisstellen-Dateien/image001.gif"></td>
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</tr>
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<tr>
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<td height=163></td>
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</tr>
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<tr>
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<td height=2></td>
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<td colspan=2 align=left valign=top><img width=25 height=2
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src="Praxisstellen-Dateien/image002.gif"></td>
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</tr>
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<tr>
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<td height=234></td>
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</tr>
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<tr>
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<td height=2></td>
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<td align=left valign=top><img width=12 height=2
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src="Praxisstellen-Dateien/image001.gif"></td>
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</tr>
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</table>
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<span style='font-family:Arial'> </span></p>
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<div style='border:none;border-bottom:solid windowtext 1.5pt;padding:0cm 0cm 1.0pt 0cm'>
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<p class=MsoNormal style='margin-left:35.25pt;text-indent:-35.25pt;border:none;
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padding:0cm'><span style='font-family:Arial'> </span></p>
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</div>
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<br clear=ALL>
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<p class=MsoNormal style='margin-left:35.25pt;text-indent:-35.25pt'><span
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style='font-family:Arial'>Datum, Unterschrift</span></p>
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</div>
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</body>
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</html>
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