Form_01_T

TRNG I HC NNG LM TP. H CH MINH

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Khu Ph 6 Phng Linh Trung- Qun Th c TPHCM

GIY NGH
V/V NGH HC TM THI V BO LU KT QU HC

Knh gi: Ban gim hiu (thng qua phng o to)

Thng tin chung v sinh vin:
H v tn: _______________________________ MSSV : _____________________
Sinh ngy_______ thng____nm sinh ________

Ni sinh:____________________

M lp:_____________Khoa/BM:__________________________________________
in thoi:___________________________ Email:___________________________
a ch lin h: S nh:__________________

p (khu ph)___________________

X (Phng)______________Huyn (Qun)___________Tnh (TP)_______________

---------------------------------------Sau khi tm hiu cc iu kin c lin quan n vic ngh hc tm thi v bo lu kt
qu hc (tm dng hc), nay ti vit giy ny knh ngh nh trng cho ti tm
dng hc t: Hc k___nm hc________n hc k___nm hc__________
Khi ht thi hn ni trn ti s hon tt cc th tc xin vo hc li theo ng thi gian
v quy nh ca trng (qu hn xem nh ti t b hc) ng thi c ngha v hc
b sung cc mn hc chnh lch gia 2 chng trnh o to ca 2 kha (nu c).
Rt mong nhn c s chp thun ca nh trng.
Ngy_____thng______nm________
K v ghi r h tn

________________________________

PHN XT DUYT CA TRNG

Cn b kim tra:

iu kin;

Khng iu kin.

kin khc:_____________________________________________________
K tn:____________________
Lnh o phng o to: ________________________________ngy .thng
Duyt ca ban gim hiu:________________________________ngy .thng