CNG HA X HI CH NGHA VIT NAM

c lp T do Hnh phc
-------------------N XIN LM TH SINH VIN
Knh gi:

- Phng Cng tc Chnh tr v Cng tc Sinh vin

- BCN Khoa/ Vin:......................................................,Trng H Bch khoa HN

Tn em l
Ngy sinh
H khu
Lp

:..........................S hiu SV:......................................................

:......................................................Nam/ N:.....................................
X:..........................................Huyn:.......................................Tnh:.....................................
:.................................................................................................Kha.....................................
Em xin lm li th:
Lm mi:
i th:
Knh mong Nh trng gii quyt.

Xin chn thnh cm n !

H Ni, ngy ........ thng ....... nm 20.......
Khoa/Vin/Cn b qun ngnh

Sinh vin