S Gio dc v o to TPHCM

Trng THPT XYZ

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

N XIN NHP HC
Nm hc 2013 - 2014

Knh gi: HIU TRNG TRNG THPT XYZ

1. H v tn hc sinh: ..................................................................................... Nam o N o
2. Ngy sinh: ............................. Ni sinh: .................................. Dn tc: ............................
3. a ch thng tr: ...............................................................................................................

4. a ch tm tr: ....................................................................................................................
5. H tn cha: ............................................................ Ngh nghip: ........................................

6. H tn m:.............................................................Ngh nghip:.........................................
7. Kt qu hc tp ca hc sinh nm hc 2012 - 2013:

Ton

Lp:.....................Trng:...........................................................................................
Hc lc:
Gii
Kh
Trung bnh
Yu
Hnh kim: Tt
Kh
Trung bnh
Yu
im trung bnh c nm cc mn:
L
Ha
Vn
S
a
Anh

8. ng k hc lp thuc ban:
Ban C bn:

A
B
C
D
Chun
Ban T nhin:

Ban X hi:

Ti xin cam kt s thng xuyn theo di kim tra, n c con (em) mnh hc tp, thc hin
ng theo cc quy nh ca nh trng.
TP. HCM, ngy.. thngnm
Cha hoc m k tn
(Ghi r h tn bn di)

H s nh km:

Hc b cp hai (bn chnh)

Bn sao giy khai sinh
Giy chng tt nghip THCS (hoc bng Tt nghip)
Bn sao h khu hoc KT3
Giy chng nhn con thng binh (nu c)
Giy gii thiu chuyn trng