4 ‘Trwéng Dai Hec Khoa Hoc Va Céng Nghé Ha N6i USTH University of Science and Technology of Han SO YEU LY LICH SINH VIEN / STUDENT CURRICULUM VITAE 6 béo danh / Admission ID: Nganh nhap hoc / Training program: 1. Ho va tén / Full name: .... 2, Ngay sinh /Date of birth ....sessesere +3. S6 chizng minh thy nhan dan //D number. sesaseteesarensnnsansnseess Noi cp / Place of I8SU6% econ eennsecne Nay c&p / Date of issue’. 4, Gidi tinh / Gender: Male /Nam Female / Na 5. Noi sinh / Place of birth (Yu cu thi sinh ghi ding theo gidy khai sinh / Please fil correct according to the birth certificate) Phutng.xé / Ward, commune.... Quan, huyén / District:. Anh 3x4em_ inh, thanh phé / Province: 6. Quée tich / Nationality 7. Dan te / Ethnicity 8, Di déng / Mobile Phone: essen cecceeeeee 9, E-mail: ceoceenes Gio iennneeneereeenneneen 40.Tinh trang hén nhan /Marital status: 1] B6c than / Single [ba két hon / Married 11, Ho tén bb / Full name of your father: 12. Ngay sinh cila b6 / Date of bith of your father 18. S6 di dong cia bé / Mobile Phone of your father: . 14, Ho va tén me / Full name of your mother: 15. Nay sinh cla me / Date of birth of your mother: ... 46, S6 di dong ciia me / Mobile Phone of your mother ?...... 17. $6 anh/chifem trong gia dinh / Number of brothers/sisters: 48. Noi 8 hign tai / Current mailing address for correspondence: $6 nha, duéng / House number, stroGt...........0eesssseeeeeesnees Phuong, xa / Ward,commun Quan, huyén / District: Tinh, thanh phé / Province: 19. H6 khau thyéng tri / Permanent Resident Address: T6 dan phé / Civil group. Phurong.x8 / Ward, commune: ‘Quan, huygn / District: -Tinh, thanh phd / Province: ‘Théng tin chiihé / Fullname of Household Naay sinh chi hg / Year of birth of household: - scene cose Gi6i tinh chi h8 / Gender of Household: CJ Male /Nam Female /Na Quan hé véi thi sinh / Relationship with candidate: .. Téi xin cam doan nhimng [oi khai trén la ding sy that. Ha NOI, Nay... HAN... MIM... Xéc nhan cia Chil tich UBND Phuong/xa Ngw0i khai ky tén