CQNG HOA XA HQI CHU NGHIA VltT NAM

0~1 HOC v ou·oc DQC lip - Tv do - Httnh phuc

THANH PH<'.> H6 CHI MINH
'J KHOA RANG H~M M~T
),
Ghi c/11i:
.J. Ph~n DANH GIA KET QUA do Tnrung Khoa ho~c can quan_ly
don vi thirc t~p ghi, ky ten vim vi trl ttrong ung tirng bu6i hQc clia
\ PHIEU TH\J'C T~p
1/
sinh vicn trong ngity.
Sinh vien: C'ti0.'fi H i0i .D-lf.N.1:1 :rtAr'J .
.!. NQi dung tham gia hqc t~p t(li co so m6i bu6i trong ngay la:
Giao ban.
Kham b~nh,
- H9i chin,
• Dieu Ira,
- Tave dem,
- Ghio d11c sfrc khoe,
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Sinh ngay: . 09. thang . 0?;, . nam . ¥(;O. . . .

Nai sinh: . . 7vth. f.;t(K. W'.I<;: . . . . . . . . . . .
Di~u trj n{>i tru, - Diiu trj ngoili tru
. . ... .. .... . . . ... . .........
Ghi •6m t~t c6ng vi~c da: .tam duqc trong bu6i (Vd: tram n rang,
nh6 m rang. v.v ... ) T6: .Q1-. .. Lap: ..11:.~ l':t .2.Cl.i.2 . . . . • . . . .
..). 0i~m danh: N~u sinh vien vAng m~t, tr~ gio, ghi d§u "V" (vi\ng),
"T" (trJ) vao 6 tuong ung cua tirng bu6i/ngay
.J. Cu6i moi d,;,t, can quan ly danh gia tirng sinh vien ve chuyen
dn, thai d,;, hqc ~P vii cac ky nl\ng thirc hanh. l N<ri 6 hi~n t~i: . ,j_M / 5 . 4i .Tluloiiq . k'~'"t' , .
.p!w~9. i.11, . qu.#J. iO ,. 1fJfC~ I . . . . . .
E>i~n tho~i lien l~c: . . O ~.'b;i '1"2.9 ;i~O.
Dia di€m thl,lc t~p: . . 1'1.a1-tt .V~ h. _l.qn._q . . . . .
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7
 DANH GIA KET QUA
(cua can bq quan ly don vj th\lc ~p)
vin tit m;li dung, danh gia,
Thungay Diem danh (chiJ' ky cua Bdc s1ph(l trdchl Ban Gldm hlju ho/c
G/do vi2n tpi cdc trirting hpc)
ounggio
-
Thir2 . .... . . .. .
vling
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Thu 3 01w.21.22, ~s
vling
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oung gio X
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vling
Thu1Aiµf.oD:>

oung gio
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Chuyen can \ --------I
Thaid(i
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Danh gia:
(Tdt/Kha/
Trung hlnhl
''1I Khongd~t)
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 DANH GIA KET QUA
DANH GIA KET QUA
(cua can quan ly dan vi thl,lc ~p)
(cua can bQ quan ly dan vi th\lc t~p)
vAn cit nqi dung, danh gia,
vAn tAt nqi dung, danh gia,
Th(rngily E>i~m danh (ehlr ky etia Bae si ph(l trtieh/ Ban Gitim hifu ho(le
Th(r ngily Di~m danh (ehil' ky eua Btie sf ph(l trtiehl Ban Gitim hiiu hope
Gido_j!jbi t(li etie tririlng hpe)
Gitio viln tpi etfe tririing hpe)
b l n, "(.'/,; ,.
Dunggilr ,I
Dung giiY
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flit
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Chuyen can
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Chuyen can I TMidq . a ~Pl;~ quan ly ky ten Thai Ky na.
Danh gia: Ki~ ~
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Danh gia: I
crbt1Kha/
1i u~QC :
(TOI/Kha/
Truog blnh/
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Tnmg binh/
Khong d~t)
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Ot~-~~l ~,J ' I KhOng d~t)
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 DANH GIA KET QUA
(cua can b(> quim ly don vi thl,l'C t~p).
vin tit n{>i dung, danh gia,
Th(r ngay Oi~m danh
D,mggicr
Thu2 ~J/c0 8 :
\'~ng
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oung gicr
Th,r ~ : X ) 8 V~ng
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o,mggicr
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Tlnr 1d~ I : l:ng
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Dung gicr
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Dung gicr
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Th tr 6 .. ... .. . .
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Thir 7. . . .. . ...
V:l.ng
--
Chuyen can Thai dQ Kfnan
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Dclnh ei(\:
( l(Jt/Kha/
Trung. hinh/
Khong d ~I)