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Dn

nh 3x4
CNG HA X HI CH NGHA VIT NAM
c lp - T do - Hnh phc

N XIN XT TT NGHIP
(Dnh cho sinh vin hc theo hc ch tn ch)

Dn
nh 3x4

Knh gi: Khoa . . . . . . . . . . . . . . . . . . . . . .


-

Em tn l: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .M s sinh vin: . . . . . . . . . . . . .
Bc o to: h: lp sinh vin:..
Chuyn ngnh o to: . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kha . . . . . . . . . . . . . . .
Ngy sinh: . . . . /. . . ./. . . . . .
Ni sinh: Huyn: . .. . . . . . . . . . . . . . . . . . . . . . . Tnh: . . . . . . . . . . . . . . . . . .
H khu trc khi vo trng: X (phng, th trn) . . . . . . . . . . . . . . . . . . . . . . . .
Huyn (qun, th x, thnh ph) . . . . . . . . . . . . . . . . . . . . Tnh/TP: . . . . . . . . . . . .
in thoi lin lc (nu c): . . . . . . . . . . . . . . .
Hin nay Em hc tch ly s tn ch theo qui nh. Nay Em lm n ny xin
c xt tt nghip.
Rt mong c s chp thun ca Ban ch nhim Khoa.
Trn trng cm n
Tp. H ch Minh, ngy . . . thng . . . nm . . . . .
Ngi lm n
(K tn, ghi r h tn)

Sinh vin np n ti khoa (Km theo: 02 nh 3x4)

KT QU XT CA KHOA
- Sinh vin tch ly c: . . . . . . . . . . tn ch.
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- ngh cng nhn tt nghip cho sinh vin.
Tp. H ch Minh, ngy . . . thng . . . nm . . . . .
Trng Khoa

Gio v

Ghi ch : Khoa tng hp danh sch trnh hi ng xt tt nghip

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