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西安电子科技大学留学生离境申请申请表Leave Mainland China Request Form
Name :
学生姓名:School belonged:
所属学院:
Departure Date:
离校时间: 电话号码:
Phone NO.Return Date:
返校时间: 护照号码:
Passport NO.:Emergency contact person:
紧急联系人员: 电子邮箱 Email:
电话号码 Phone:
请假理由 Reason(s) for asking leave:
Any accident occurring during the leaving time, I will take the full responsibility.
离校期间发生任何意外与学校无关,一切后果自负The student who fail to register on time, or do not fulfill the leave formalities will face the same punishment as those who are absent.
逾期到校、未履行销假手续的按照旷课处理.Signature of Student: d m y
学生签名: 日 月 年
机票信息:
please provide Copy of your fly/train ticket(s)
国际教育学院意见
Opinion of School of International Education
Signature and seal:
签字盖章: