國立中山大學學生延長休學申請書

National Sun Yat-sen University

Application Form for Extending the Deadline of voluntary Suspension

休學証：中 ( ) 休字 第 號
Suspension certificate no.：
申請日期 Application date ：2019/9/6

學號 姓名
Student ID
M073090071 Name
林泓儒

系所別
Department/College
光電工程學系碩士班

休學紀錄 自 107 學年度第 2 學期起休學 1 學期，原因: 學業成績

Suspension Record 共計已休學1學期
延長休學期間 自108學年度第1學期起休學1學期
Apply to Extend
Suspension Period From 1 semester, academic year 2019 ~ 2020 for 1 semester
延長修學原因
Reason for Extending 出國
Suspension Period

聯絡電話 聯絡地址 320桃園縣中壢市中山里七鄰榮安十五街七十五巷三

0918692565
Contact No. Address 號五樓
家長或監護人簽
章 (大學部日間部
學生簽章 學生) 申請人 本人
Applicant
Parent or legal guardian
signature (applicable to
undergraduate students)
休學証 □ 自取 Pick-up in person：領證簽收 signed by ___________________
領取方式 ■ 郵寄 By post (請附貼足郵資、填妥收件人姓名地址之掛號回郵信封) (Please provide a fully addressed envelope
Suspension Certificate
Collection Method with sufficient postage)

導師／指導教授 系所主管
Faculty/Advising Professor Department/Supervisor

辦理學生團體保險相關事宜
Student Group Insurance Matters
學務處生活輔導組 總務處出納組
Advice and Guidance Division of Office of Student Affairs Payroll and Cashier Division of Office of General Affairs

註冊課務組承辦人 註冊課務組組長
Person in Charge in Registration Head of Registration Division

已修業學期數：
No. of Semesters attended: _____semesters：
過去休學紀錄：
Past record of suspension:________ semesters：
辦理順序： 導師 / 指導教授 → 系所主管 → 學務處生活輔導組 → 總務處出納組 → 註冊課務組
【本申請書送交註冊課務組，申請人收到註冊課務組核發之休學證後，延長休學手續方始完成。】
Application Faculty/Advising Professor → Department Supervisor → Advice and Guidance Division → Payroll and Cashier Division → Registration
procedure： Division
【The extension of suspension procedure is only considered complete after submitting the application form to the Registration Division,
followed by receiving the suspension certificate issued by the Registration Division.】

備註 1. 延長休學請附原休學證，無需再辦理離校手續；延長休學期間，為維護同學權益，請仍投保學生團體保險。
2. 休學累計以四學期為原則，期滿因重病或特殊事故等原因須再申請休學者，經專案簽請校長核准後，酌予延長休學
年限，但至多以四學期為限。
3. 休學期間應徵服役，應檢具在營服役證明文件，申請延長休學至服役期滿止，服役期間不計入休學年限內；服役期
滿，應檢具退伍令申請復學。
4. 學生因懷孕，得檢具產檢證明申請休學，其休學期間不計入休學年限；休學期滿，應檢附子女出生證明及相關證明
文件申請復學。

Note 1. To extend the suspension period, please provide the original copy of the suspension certificate. University exit (leave) procedure is not
required. To ensure the student's right is not compromised, during the suspension period, the student should remain covered by student
group insurance.
2. The limit students are allowed to suspend studies is four cumulated semesters in principle. For those who need to extend beyond the
limit due to special circumstances or severe illness, application needs to be made and approved by the President of the University. In
general, the maximum number of semesters allowed for suspension should not exceed four semesters.
3. If the student is called to military duty during the suspension period, the student is allowed t to extend the suspension period until the
military service is completed with proof of military discharge. Time spent in military service will not be counted towards the
suspension period. Once completing the military service, application for readmission can be made with military service discharge order.
4. Students who apply for suspension due to pregnancy are required to present the proof of prenatal exams. The pregnancy period will
not be counted towards the maximum time limit for suspension. Upon the end of suspension, application for readmission can be made
with the child(ren)'s birth certificate(s) or any other relevant documents.