Trng HBK H Ni

Phng CT Chnh tr & CT Sinh vin

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nh
4x6

CNG HO X HI CH NGHA VIT NAM

c lp T do Hnh phc

N XIN THAM GIA

XT TNG HC BNG.................................................................
Knh gi : Phng Cng tc Chnh tr v Cng tc Sinh vin

* S lc v bn thn:
H v tn.................................................................................M s SV........................................
Gii tnh..........................................................................................................................................
Lp............................................Kha...................................Khoa/vin.........................................
Nm sinh.........................................Ni sinh...................................................................................
i tng chnh sch ........................................................................Dn tc.................................
in thoi.............................................................................email..................................................
S ti khon:....................................................Ngn hng...............................................................
S CMT:......................................................Ni cp.................................ngy cp........................
* Hon cnh gia nh: (thuc din chnh sch, c kh khn v iu kin kinh t, sc khe,...)
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* Tnh hnh hc tp:(kt qu hc tp TB cc hc k, im rn luyn, kh nng hc tp,..)
- im TBC L1 nm hc 2008-2009: ...........................................................................
- im TBC kt qu rn luyn nm hc 2008-2009:....................................................
- Cc thnh tch khc (np bn photo cc giy chng nhn c gi tr):
+ ....................................................................................................................................
+ ....................................................................................................................................
+ ....................................................................................................................................
* a ch gia nh sinh vin ( a ch gi th)
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Nay em vit n ny xin c tham gia xt nhn hc bng:
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Em xin trn trng cm n.

H ni, ngy ...... thng ...... nm

2009
Sinh vin
(K v ghi r h tn)

Lu : Sinh vin np 01 ti h s gm:

n xin tham gia xt tng HB, cc giy t khc v 02 nh mu 4*6cm