HC VIN CHNH TR H CH MINH

H CH MINH
HC VIN BO CH V TUYN TRUYN

CNG HO X HI CH NGHA VIT NAM

c lp T do Hnh phc

H Ni, ngy

thng

nm 2015
Mu

PHIU NG K THAM GIA LP BI DNG

NGHIP V S PHM
1. H v tn:...................................................2. Gii tnh:.................................
2. Ngy, thng, nm sinh:...............................3. Dn tc:...................................
4. Ni sinh:..........................................................................................................
5. Ni ng k HKTT:........................................................................................
6. Ni lm vic hin nay (Nu l sinh vin th ghi r tn lp, tn trng):........
.............................................................................................................................
.............................................................................................................................
7. Chng minh th nhn dn s:.........................................................................
Cp ngy:.......................................................Ni cp:.......................................
8. tt nghip:
- Trung hc chuyn nghip
- Cao ng
- i hc
- Sau i hc
9. ng k hc vo thi gian:
- T 17h30 n 21h30 cc ngy trong tun (tr th 7, CN)
- T 07h30 n 11h30 cc ngy th 7, ch nht trong tun
Ti xin cam oan thng tin trn l hon ton ng s tht, nu c vn g
sai ti chu hon ton trch nhim.
NGI NG K HC
(K v ghi r h tn)

nh 3 x 4

nh 3 x 4
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