SH-QT9.BM9.

L LCH KHOA HC
(Dng cho hc vin cao hc)

I. S lc l lch:
H v tn:............................................................................. Gii tnh:
nh 4x6
Sinh ngy:
.........
.........
thng
nm
.........
Ni sinh(Tnh mi):.............................................................................................................
Qu qun:............................................................................................................................
Chc v: ............................................................................................................................................
n v cng tc: ................................................................................................................................
Ch ring hoc a ch lin lc:......................................................................................................
...........................................................................................................................................................
...........................................................................................................................................................
in thoi CQ:............................... in thoi NR:
........................................................
........................................................
........................................................
in thoi di
ng: ..............................................
Fax:................................................. E-mail :.....................................................................................
II. Qu trnh o to:
1. Trung hc chuyn nghip (hoc cao ng):
- H o to(Chnh quy, ti chc, chuyn tu)
:
........................................................
Thi gian o to: t. . . . /. . . . .. n.
- Trng o to................................................................................................................................
- Ngnh hc: .....................................................
Bng tt nghip t loi
:
...........................................................................
...........................................................................
...........................................................................
...........................................................................
2. i hc:
- H o to(Chnh quy,ti chc, chuyn tu) :
Thi gian o to: t. . . . . /.
n . . . . . /. . ..
- Trng o to................................................................................................................................
- Ngnh hc: .....................................................
Bng tt nghip t loi
:
...........................................................................
...........................................................................
...........................................................................
...........................................................................
3. Thc s:
- H o to:: ....................................................
Thi gian o to: t /.n/

- Chuyn ngnh hc:..........................................................................................................................

- Tn lun vn:..................................................................................................................................
...........................................................................................................................................................
- Ngi hng dn Khoa hc:...........................................................................................................
4. Trnh ngoi ng (Bit ngoi ng g, mc no): ...............................................................
III. Qu trnh cng tc chuyn mn k t khi tt nghip i hc:
Thi gian
Ni cng tc
Cng vic m nhn

IV. Cc cng trnh khoa hc cng b:

Ti cam oan nhng ni dung vit trn y l ng s tht.
Ngy
thng
nm
NGI KHAI K TN

Hc vin phi vit trn my tnh theo mu.