北京师范大学留学研究生学籍变动申请表.doc

北京师范大学留学研究生学籍变动申请表BeijingNormalUniversityChangeofStudentStatusFormforInternationalGraduateStudents学号StudentID№中文名Chinesename英文名Englishname部院系名称School专业Major学生类别Program经费来源SourceofFundingo自费/Self-supportingo中国政府奖学金/CGSo孔子学院奖学金/CISo其它/Other联系方式ContactInformation电话/Phone:电子邮件/E-mail:通讯地址/PostalAddress:学籍变动在相应的□内划√StatusChangePlease(√)checktheappropriateanswer□休学休学期限:年月至年月StudyleaveDatesfromwhichStudyleaverequested:From:________To:________□复学自年月开始复学护照号码:ResumingstudyResumestudyfrom:____________Passport№:___________申请JW202表:□是(□自取/□邮寄)□否ApplyforJW202form:□Yes(□Self-pickup/□mailto)□No邮寄地址/Mailaddress:□延长学习期限延长至年月ExtensionofstudyperiodExtendtill:_________________□提前毕业提前至年月毕业EarlygraduationGraduatein:_______________________□退学自年月日起退学WithdrawalfromschoolWithdrawalstartson:________________学籍变动原因ReasonforRequest(请写明理由Pleasestatethereason)学生本人签名Applicant’ssignature:年year月month日day导师意见Academicadvisor’ssuggestion:导师签名Signature:年月日部院系意见School’ssuggestions:若延长学习期限,请确认学生是否修完所有课程:□是□否负责人签字Signature:(公章)年月日研究生院意见GraduateSchool’ssuggestions:负责人签字Signature:(公章)年月日留学生办公室意见InternationalStudentsOfficesuggestions:负责人签字Signature:(公章)年月日¬请仔细阅读备注并双面打印Pleasereadthenoteandprintonbothsides备注Note:申请须由申请者本人办理并签名,若委托他人代办,须附《委托书》;TheApplicationformmustbefilledinandsignedpersonallybytheapplicant,otherwisepleasesubmitLetterofattorney;本表请附《成绩单》;Pleaseattachyourtranscripttothisform;复学需提供