CNG HA X HI CH NGHA VIT NAM

nh c lp T do Hnh phc
(3 x4) ------------------------

N XIN CP HC BNG

Knh gi: Qu hc bng V nh Liu

Ti tn l:.................................................................................................................................
MSSV/MSHS (nu c)............................................................................................................
S CMND................................................Ngy cp.......................Ni cp..............................
Sinh ngy:................................................Ni sinh:..................................................................
Dn tc:....................................................Tn gio:.................................................................
H khu thng tr:.................................................................................................................
Ch hin nay:........................................................................................................................
in thoi lin lc:...................................................................................................................
Ti ang theo hc nm th(*) h(**):ngnh............................................
ti Trng................................................................................................................................
Ti c kt qu hc tp nh sau:
im trung bnh nm th:.(nm hc 2016-2017):........................................
im trung bnh chung tch ly:................................................................................
Ti rt mong mun nhn c hc bng V nh Liu. Cn c thng bo ca Qu
hc bng V nh Liu v vic nhn h s xt cp hc bng nm hc 2017-2018, ti
nhn thy mnh iu kin, v vy ti lm n ny xin Qu xem xt h s ca ti.
Xin gi km theo n ny:
- Bng im (c xc nhn ca gio v Trng);
-
-
., ngy thng nm 2017
Ngi vit n
Ch k

Ghi ch:
(*): Nm hc 2017-2018 bn ang hc l nm th my. (H v tn)
(**): Thuc h my nm: H 5 nm, h 4 nm ri,
h 4 nm, h 3 nm hay h 2 nm.
V d: Ti ang theo hc nm th 4 h: 4 nm ri
ngnh: Xy dng ti Trng i hc Bch Khoa i
hc Quc gia Tp. HCM.