CNG HA X HI CH NGHA VIT NAM
THNH ON TP. H CH MINHON TNCS H CH MINH
BCH ON TRNG H BCH KHOA
***
M phiu: [Tn Chi on]_[MSSV]_2015PHIU THNG TIN ON VIN NM HC 2014 -
2015
I. THNG TIN C NHN
1. H v tn (ch IN HOA):NG C PHC
2. MSSV/MSCB: 61202889 3. Chi on: HC12HLY
4. Ngy thng nm sinh: 12/06/1994 5. Gii tnh: Nam
6. Dn tc: kinh 7. Tn gio: khng 8. CMND:191835282
9. Qu qun (x, huyn, tnh/tng ng): Ph Thun, Ph Vang, TT- Hu
10. H khu thng tr (x, huyn, tnh/tng ng): Ph Thun, Ph Vang, TT-
Hu
11. a ch tm tr: KTX H Bch Kha TP.HCM
12. Email: [email protected] 13. in thoi: 0938146361
14. Ngi thn (b/ m):Ng c Xuyn 15. in thoi:0543858361
II. THNG TIN ON V
14. Ngy vo on: 26/3/2012 15. Ni vo on: Trng THPT Thun An
16. Tnh trng on tch (nh x vo ( nu c):
(S on vinNu cn, ni lu tr l:
( on khoa
( T bo qun
( Khc: .
(Th on vinNu cn, ni lu tr l:
( on khoa
( T bo qun
( Khc: .
(Ngh quyt kt np on vin
(Ngh quyt ri)Nu cn, ni lu tr l:
( on khoa
( T bo qun
( Khc: .
(Mt ton b on tch
17. Ngy vo Hi Sinh vin Vit Nam:
18. Tham gia lp bi dng nhn thc v ng: ( C ( Khng.
Nu c, ghi r kt qu: nm
19. Ngy vo ng (d b): 20. Ngy vo ng (chnh thc):
21. Chc v ng, on, Hi hin ti: on Vin
XC NHN CA CHI ONTP. H Ch Minh, ngy27 thng4 nm 2015
TM. CHI ONNgi thc hin
B TH(k v ghi r h tn)
Ng c PhcMU 2
