北京师范大留学研究生学籍变动申请表.doc

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1、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ContactInforma

2、tion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№:_______

3、____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WithdrawalfromschoolWithdrawalsta

4、rtson:________________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’

5、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:1、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》；TheApplicationformmustbefilledinandsignedpersonallybytheapplica

6、nt,otherwisepleasesubmitLetterofattorney;2、本表请附《成绩单》；Pleaseattachyourtranscripttothisform;3、复学需提供护照复印件；因病休学、因病休学后复学需附医院证明；服兵役休学、兵役结束复学需附军队“服兵役通知书”；休学、退学者需同时领取并完成《北京师范大学留学生离校转单》。Incaseofresumingstudypleaseprovidethephotocopyofyourpassport;incaseofsickleaveo

7、rstudyresumingaftersickness,providemedicalcertificates;incaseofstudyleaveorresumingstudyaftermilitaryservicethestudentmustprovideArmyinductionnotice;studentswhoapplyforstudyleaveorwithdrawalmustalsofillout«BeijingNormalUniversitySchoolLeaveForm»;4、本表一式4份，研

8、究生院综合处一份，部院系一份，留学生办公室一份，学生本人一份Theformtobesubmittedinquadruplicate.Oneoriginalcopyforeachinstitution:Graduateschool,department/faculty/school/college,InternationalStudentsOfficeandonecopyfortheapplicant.