Mu: sinh vin

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
nh (4 x 6)

BN T GII THIU CA HC SINH SINH VIN NGH XT NHN

HC BNG YAMADA
T 2, HC 2014-2015
I. THNG TIN C NHN
H v tn (Vit in hoa):.......................................................................................................................
Gii tnh:..............................................................................................................................................
Ngy, thng, nm sinh:........................................................................................................................
Dn tc:................................................................................................................................................
Chng minh th nhn dn s: .................................Ngy cp:.......................Ni cp:.......................
H khu thng tr:............................................................................................................................
Ni hin nay: ...................................................................................................................................
Kha, ngnh, Trng hc:..................................................................................................................
in thoi:........................................................: Email:.......................................................................
S thch c nhn:..................................................................................................................................
Nng lc ni tri:.................................................................................................................................
im hc k 1 nm hc 2014-2015:..................................................................................................
Xp loi rn luyn hc k 1 nm hc 2014-2015:...............................................................................
tng c nhn hc bng: Tn hc bng?Tr gi hc bng?Thi gian nhn hc bng?n v t
chc cp hc bng?n v t chc trao hc bng?
.............................................................................................................................................................
.............................................................................................................................................................
Tm tt thnh tch hc tp, rn luyn v kt qu nghin cu khoa hc cc nm hc trc:...............
.............................................................................................................................................................
.............................................................................................................................................................
Cc hot ng x hi, on th ... tham gia (ghi r chng nhn, nu c):.....................................
...............................................................................................................................................................
...............................................................................................................................................................
c m, K hoch hc tp v d nh ngh nghip trong tng lai:...................................................

II. THNG TIN V GIA NH

1. H tn b:.......................................................................Nm sinh:...............................................
in thoi lin lc:..........................................................................................................................
Ngh nghip:...................................................................................................................................
Ni cng tc:...................................................................................................................................
Ni hin nay:................................................................................................................................
2. H tn m:.......................................................................Nm sinh:...............................................
in thoi lin lc:..........................................................................................................................
Ngh nghip:...................................................................................................................................
Ni cng tc:...................................................................................................................................
Ni hin nay:................................................................................................................................
3. Anh ch em rut (H v tn, nm sinh, ngh nghip tng ngi - nu c)
L con th my trong gia nh:
Hon cnh gia nh:.........................................................................................................................

.
III. L DO XIN HC BNG (nu di c th vit nh km)
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
IV. LI CAM OAN: Em xin cam oan bn t khai trn y hon ton ng s tht, nu sai em
s hon ton chu trch nhim.
H Ni, ngy
(k v ghi r h, tn)

thng
nm 2015
Ngi khai