B GIO DC V O TO

TRNG AI HOC CONG NGHE

SAI GON

CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

GIY XC NHN
H v tn hc sinh (sinh vin):....
Ngy sinh://..Gii tnh:

Nam

CMND s: .............................. ngy cp ....../......./......... Ni cp: ........................

M trng theo hc (m quy c trong tuyn sinh H, C, TCCN): STU
Tn trng: Trng i hc Cng Ngh Si Gn
Ngnh hc:...
H o to (i hc, Cao ng, TCCN, Lin thng):.
Kho:... Loi hnh o to: Chnh quy
Lp:. S th HSSV:.
Khoa:.......
Ngy nhp hc:../../.. Thi gian ra trng (thng/nm):...//
(Thi gian hc ti trng: .. thng)
- S tin hc ph hng thng:............................ng.
Thuc din:
- Khng min gim
- Gim hc ph
- Min hc ph
Thuc i tng:
- M ci
- Khng m ci
- Trong thi gian theo hc ti trng, anh (ch) ...........................................
khng b x pht hnh chnh tr ln v cc hnh vi: c bc, nghin ht, trm
cp, bun lu.
Tp HCM, ngy..thng..nm 2012
TL. HIU TRNG