TRNG I HC LC HNG

PHNG O TO

PHIU DN HNH LM BNG TT NGHIP I HC

(p dng cho sinh vin c xt tt nghip)
Sinh vin in y v chnh xc cc thng tin sau y

MSSV:...................................................................................
H v tn: .............................................................................
Gii tnh:

Nam

Dn hnh
3x4

Ngy, thng, nm sinh:.........................................................

Ni sinh (ch cn ghi tnh):..................................................
Lp:.......................in thoi lin lc:.................................
Yu cu:
Dn 1 nh (3 x 4) mi chp khng qu 6 thng (Nam tht c vt; N mc o di)
L ph lm bng 100.000 (Mt trm nghn ng)
a im:

Phng o to CS1
Bin Ha, ngy

thng

PHNG O TO

K TN

NGI NHN N

(Ghi r h tn)

nm

(K tn, ghi r h tn)

BIN NHN
(Sinh vin in y thng tin)
Phng o to - Trng i hc Lc Hng nhn phiu dn hnh lm bng tt nghip i hc
Ca sinh vin: .......................................................................... MSSV: ...................................
Lp: ..................................... Khoa:..........................................................................................
Bin Ha, ngy thng nm
PHNG O TO
NGI NHN N
(K tn, ghi r h tn)

Sinh vin phi xut trnh bin nhn ny khi nhn Bng Tt nghip