CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

N XIN PHC KHO IM THI C

IK

(Dnh cho sinh vin h tn ch)

Em tn l : ............................................................................ M s sinh vin: .....................................
Lp sinh hot: ................................... Em xin phc kho im thi cui k cc hc phn sau y:
TT M

P HC PHN

Em xin cm n!

TN HC PHN

Hc k/ nm hc im thi

Nng, ngy ......... thng ......... nm 201 ......

Ngi lm n
(K v ghi r h tn)

IN NH N
h ng o to nhn n in phc kho c a sinh vin
th sinh vin: i vi cc hc phn:
TT M
P HC PHN
TN HC PHN
Hc k/ nm hc

Ngy
H

thng
nm 2013
N
N NH N H

Lu : inh vin phi ghi ch nh c th ng tin v np n ng thi hn uy nh, ch phc kho im thi
cui k i vi hc phn l thuy t.