ceNG Hoa xA HeI cHu NGHia vIET NAM

DQc l$p - T1r do - H4nh phric

TRrrNc rAur nAo TAo

'l
urun ttlc
rl
YTf;THEoNHUcAuxA Hor
PHIE,TI DANG KV

Lop:

Kfnh gfri: DAI HQC Y otIQC THANHpUO uO cui MINH

TRUNc TAMDAo T4o xuAx l[c v rn rHEo NHU cAu xA HeI

1. H9 t6n khai sinh (chfi in hoa):......... .......... Ph6i:

2. Ngdyrth6ng, n[m sinh: ,...,......o...o.....o..,........Noi sinh (tinh)l ..,.. .. Ddn tQc: .

3. Dia chi li6n h0:

4. Diqn tho4i: Email:

5. Don vi c6ngtttc:

O. fOt nghiQp n6m: ........ Chuy6n khoa:

7 . Chuy0n khoa dang c6ng titc: Thdm niOn c6ng tdc

Sau khi xem kY nQi dung va diOu kiQn hgc lop

.., t6i xin d[ng ky theo hgc lop noi trOn.

N6u dugc x6t vio hgc t6i xin cam k6t:

-Cfr6p hdnh nghi€m chinh nQi qui kf lu{t cira nhd trudrng dC ra.
-E6ng hgc phi dAy dri ngay ttr dAu kh6a hgc.
-Thyc hign tl6y dri nghia vp cria ngudi di hqc.
-Sau khi l6p hgc dd khai giang, nriu t6i tp y nghi hgc v6i b6t cri l;f do gi, ho{c vi vi ph4m
k! luQt md bi buQc th6i hgc thi t6i hoan toan chiu trtich nhiQm vi kh6ng ddi nha truong hoan tri
hgc phf dE nQp.
T6i xin hria sE thgc hiQn tOt ntrfing di6u da cam k6t n6u tr6n.

TP. HO Chi Minh, ngdy..... ..thdng.......ndm 20

Nguli dnng ky
(Ky tAn, ghi rd hO t1n)