CNG HA X HI CH NGHA VIT NAMc lp T do Hnh phc-------------------------

BN NG K THAM GIA CUC THIN sinh thanh lch i hc Quc gia H Ni ln IV i s VNU 2015

Knh gi: Ban T chc cuc thi

Tn ti l: ....Tn gi khc:...Lp: .. Khoa:............

Trng

Ngy sinh:. ..Qu qun:..Ch hin nay: .....Chiu cao: .cm; Cn nng:..kg; Vng 1:....cm; Vng 2:cm; Vng 3:...cmS in thoi:..........E-mail:.......im tng kt ca hc k gn nht:Chc v (on TN, Hi SV, lp, CLB nu c): ...............

tham gia Cu lc b (t/i/nhm nu c): ..

Cc gii thng, bng khen, giy khen, danh hiu (nu c):

tng tham gia cc hot ng no ca on Thanh nin/Hi Sinh vin.......................................................Mt vi iu v bn thn:

- S trng/nng khiu/ kh nng ca bn thn: .. ........

- S thch: ......

........

- iu khng thch nht bn thn: .....................................................................................................................................................................................- Thnh cng ln nht t c: ......- M c trong tng lai: ......- Cu ni yu thch nht ..........................................................................- Thn tng:.........................................................................................................................................- Mt vi thng tin c nhn khc: .............

Mt vi iu v cuc thi:- L do tham d cuc thi: ..............- iu mong i nht cuc thi ny:........... ................................- Nu l thnh vin Ban Gim kho, bn s t cu hi g cho phn thi ng x?

- Nu c gi mt thng ip ti hc sinh, sinh vin ton HQGHN trn sn khu m chung kt cuc thi ny, bn s gi thng ip g: .

........

Ti tm hiu y cc quy nh ca cuc thi v cam kt nghim tc thc hin cc ni dung sau y:

1. Thc hin nghim tc Th l ca cuc thi v chp hnh mi quy nh ca Ban T chc Cuc thi N sinh thanh lch HQGHN ln IV i s VNU 2015.

2. Khng b cuc thi gia chng v tham gia y cc bui tp, cc chng trnh d ngoi cng nh cc ni dung ca cuc thi.

3. Trung thc trong khai bo cc thng tin c nhn.

Sau khi nghin cu k hoch v th l ca cuc thi N sinh thanh lch HQGHN ln IV, ti xin ng k tham gia cuc thi v ng chp hnh nghim chnh quy nh ca Ban T chc. Ti cam oan nhng li khai trn l ng s tht v xin hon ton chu trch nhim.H Ni, ngy thng nm 20 Xc nhn ca on Thanh nin/Hi Sinh vin Trng/Khoa

Ngi ng k

(K v ghi r h tn)

Lu : Thi gian np h s t ngy 01/12/2014 n ngy 01/01/2015 ti Vn phng on TN Hi SV HQGHN (P.605 Nh iu hnh HQGHN, 144 Xun Thy, Cu Giy, HN). Cc th sinh lu gi 4 nh (trong c 1 nh chn dung, 3 nh ton thn). File mm ca nh v h s gi vo a ch daisuvnu2015@gmail.com.PAGE