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\par 
\par 
\par \tab \tab \tab \tab \tab \tab Buenos Aires, ..... de .................. de ...........
\par 
\par 
\par Subcomisi\'f3n de Doctorado del
\par Departamento de Matem\'e1tica
\par Fac. de Cs. Exactas y Naturales,
\par Universidad de Buenos Aires.
\par 
\par Estimados Se\'f1ores Miembros de la Subcomisi\'f3n:
\par 
\par \tab Tengo el agrado de dirigirme a Uds. a fin de solicitarles tengan a bien incluir las siguientes materias en mi Plan de Tesis Doctoral
\par 
\par Denominaci\'f3n: ...................................................................................................................
\par Dictada por: ............................................................... (}{\i nombre y cargo de los profesores}{)
\par Lugar: .................................................................................................................................
\par Per\'edodo de la cursada: ........................................................................................................
\par Fecha de aprobaci\'f3n: .........................................................................................................
\par Calificaci\'f3n: .......................................................................................................................
\par Puntaje asignado por el Departamento (}{\i si correspondiese}{): ..............................................
\par 
\par 
\par Denominaci\'f3n: ...................................................................................................................
\par Dictada por: ............................................................... (}{\i nombre y cargo de los profesores}{)
\par Lugar: .................................................................................................................................
\par Per\'edodo de la cursada: ........................................................................................................
\par Fecha de aprobaci\'f3n: .........................................................................................................
\par Calificaci\'f3n: .......................................................................................................................
\par Puntaje asignado por el Departamento (}{\i si correspondiese}{): ..............................................
\par 
\par y adem\'e1s se les acredite el puntaje correspondiente.
\par 
\par 
\par \tab Saluda a Uds. muy atentamente.
\par 
\par 
\par \tab \tab \tab \tab \tab \tab Lic. ..................................................................
\par 
\par \tab \tab \tab \tab \tab \tab ..........................................................................
\par \tab \tab \tab \tab \tab \tab \tab \tab        Firma
\par 
\par \tab \tab \tab \tab \tab \tab .........................................................................
\par \tab \tab \tab \tab \tab \tab Firma y aclaraci\'f3n del Consejero de Estudios
\par 
\par }}