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This can be used when you are signing before a notary. If you
are not using a notary, you can delete the portion at the bottom
(“Sworn before me…”)
Certification of Accuracy
I, the undersigned, [name of translator and degree], being duly sworn, depose and say that [describe
your credentials here, eg. I hold a doctorate in French language and literature], that I am fluent in both
the English and the French languages, and that I certify that the attached English translation, of the
[describe document, eg., birth certificate / marriage license] of [name], from the annexed document in
the French language, is a true and complete translation to the best of my knowledge, ability and belief.
.
_______________________________
Translator
Sworn before me this day,
.
exp.
Notary Public
State of Wisconsin
NAME MERKA, Stanislav
No.
SECOND YEAR, FIRST STAGE
YEAR 1971-1972
Session: June 1972
No. 2012
GRADES
WRITTEN EXAMS
Biophysics
Biochemistry
Histology-Embryology
Physiology
Anatomy
Psychology
Social Science & Economy
26/40
25/40
20.5/40
21.75/60
42.5/60
8.75/20
TOTAL
144.50/260
RESULT
PASSED
PRACTICAL EXAMS
Social Science & Economy
Biophysics
Chemistry
Histology-Embryology
Physiology
Anatomy
FINAL RESULT
20/20
13/20
11/20
17/20
17/20
PASSED
Mr. MERKA, Stanislav
FIRST YEAR, SECOND STAGE
YEAR 1972-1973
WRITTEN EXAMS
SESSION 1
No. 3039
SESSION 2
No. 3005
22
22
21
11
11
11.5
3
8
26.5
18
25
16.5
5
18
10
14
TOTAL (out of 420)
109.5
133
RESULT
REFERRED
PASSED
6
4
1
53.5
35
16
54
36.75
16
TOTAL (out of 20)
105
106.75
RESULT
REFERRED
PASSED
BIO-CLINICAL INSTRUCTION
Bacteriology
Anatomy
Pharmacology
Hemobiology
Genetics
Parasitology
Experimental Medicine
General Radio.
coef.
2.5
2
2
1.5
1.5
1
1
1
PATHOLOGY
Medical Semiology
Surgical Semiology
Emergency Medicine
coef.
TUTORIALS
Bacteriology
Hemobiology
Pathological Anatomy
Pharmacology
Parasitology
Clinical Apprenticeship
(of 20)
(of 20)
(of 20)
(of 20)
(of 20)
(of 20)
1ST Semester
2nd Semester
FINAL RESULT
18.5
14
14
10
17
16
16
REFERRED
REFFERED
Mr. MERKA, Stanislav
No.
YEAR 1973-1974
FIRST YEAR, SECOND STAGE
SESSION 1
No. 3085
WRITTEN EXAMS
BASIC SCIENCE
Bacteriology-Virology-Immunology
Pathological Anatomy
Pharmacology
Hemobiology
General Genetics
General Parasitology
Experimental Medicine
General Radio.
16.5/50
16.5/40
22/40
19/30
8/20
17/20
10/20
11/20
TOTAL (out of 420)
120/240
RESULT
PASSED
PATHOLOGY
Medical Semiology
Surgical Semiology
Emergency Medicine
70/120
38/80
17/20
TOTAL
125/220
RESULT
PASSED
PRACTICAL EXAMS
Bacteriology
Hemobiology
Pathological Anatomy
Pharmacology
Parasitology
Clinical Apprenticeship
FINAL RESULT
10
15
PASSED INTO SECOND YEAR, SECOND STAGE
LAST NAME
FIRST NAME
MERKA
Stanislav
SECOND YEAR, SECOND STAGE
(1st year, 2nd part of 2nd stage)
YEAR 1974-1975
SESSION 1
No. 4059
GRADE
WRITTEN EXAMS
Pleuropulmonary
Endocrinology
Diseases of the Digestive Tract
Medicine
Surgery
(of 60)
(of 60)
31 PASSED
30 PASSED
(of 40)
(of 20)
12
11.75
16.75
9.5
23.75 REFERRED
26 REFERRED
TOTAL (of 60)
General Surgery, Traumatology
& Surgical Specializations
Gen, Sur, -Traumatology
Otorhinolarynology
Opthamology
Stomatology
(of 60)
(of 10)
(of 10)
(of 10)
(of 60)
(of 30)
(of 15)
(of 15)
TOTAL (of 60)
Hospital Apprenticeship
Gynecology-Obstetrics
FINAL RESULT
GRANTED
GRANTED
(of 60)
TOTAL (of 60)
Infectious Diseases, Parasitic
Disease & Dermatology
Infectious Disease
Parasitic Disease
Dermatology
SESSION 2
No. 4020
GRADE
(of 20)
10.5
7.5
6
6.5
30.5 PASSED
GRANTED
16.5
6
6.5
12
7.5
10.5
26 REFERRED
30 PASSED
18 – 18 – 18
29 REFERRED
35 PASSED
REFERRED
PASSED w/a certificate
to be validated
LAST NAME
FIRST NAME
MERKA
Stanislav
THIRD YEAR, SECOND STAGE
(2nd year, 2nd part of 2nd stage)
YEAR 1975-1976
WRITTEN EXAMS
Cardio-Vascular Diseases
Infantile Diseases
Nephrology & Urology
Blood Diseases & Cancer
Neurology, Neurosurgery
(of 60)
(of 60)
(of 60)
(of 60)
(of 60)
HOSPITAL OFFICES
(of 20)
1st Quadrimester
2nd Quadrimester
3rd Quadrimester
SESSION 1 June 1976
No. 5014
SESSION 2 September
No. 5035
GRADE
GRADE
30.5 PASSED
36 PASSED
25 REFERRED
19 REFERRED
26 REFERRED
GRANTED
GRANTED
36 PASSED
ABSENT
15 REFERRED
REFERRED
PASSED w/ 2 certificates
to be validated
8.75 REFERRED
30.75 PASSED
17
19
18
FINAL RESULT
2nd YEAR, 2nd STAGE
Diseases of the Digestive Tract
LAST NAME
FIRST NAME
MERKA
Stanislav
FOURTH YEAR, SECOND STAGE
(3rd year, 2nd part of 2nd stage)
YEAR 1976-1977
YEAR 1977-1978
Session 1
No. 6054
Session 2
No. 6027
Session 1
No.
GRADE
GRADE
GRADE
(of 40)
(of 20)
21
7
27
10
(of 60)
28 REFERRED 37 PASSED
(of 60)
(of 20)
(of 20)
(of 20)
10
11.5
10.75
(of 60)
32.25 PASSED GRANTED
(of 60)
37 PASSED
GRANTED
5 REFERRED
31.5 PASSED
25.5 REFERRED
WRITTEN EXAMS
Rumatology & Orthopedics
Rumatology
Orthopedics
TOTAL
Social, Preventative Medicine, Medical Economy
Forensic Medicine
Industrial Medicine
Hygiene
TOTAL
Psychiatry & Medical Psycho.
3rd Year 2nd Stage
Blood Disease-Cancer
Neurology
PRACTICAL EXAMS
Forensic Medicine
Industrial Medicine
Hygiene
OPTIONAL CERTIFICATES
(of 20)
(of 20)
(of 20)
33.00 PASSED
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