Mau Phu Luc Cua Thong Tu 10

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Phụ lục (Ban hành kèm theo Thông tư số 10/2014/TT-BGDĐT ngày 11/4/2014 của Bộ trưởng Bộ Giáo dục và Đào tạo) Mẫu số 01: Báo cáo tiến độ học tập Mẫu số 02: Đơn xin chuyển nước/trường/ngành học Mẫu số 03: Đơn xin gia hạn thời gian học tập ở nước ngoài Mẫu số 04: Báo cáo tốt nghiệp Mẫu số 05: Đơn xin chuyển từ trường học ở nước ngoài về học tại Việt Nam Mẫu số 06: Báo cáo thành tích của cá nhân lưu học sinh Mẫu số 07: Báo cáo về việc tuyển sinh và cử công dân Việt Nam ra nước ngoài học tập Mẫu số 08: Thống kê số lượng công dân Việt Nam được cử ra nước ngoài học tập Mẫu số 09: Thống kê danh sách công dân Việt Nam được cử ra nước ngoài học tập.

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Transcript of Mau Phu Luc Cua Thong Tu 10

  • Ph lc

    (Ban hnh km theo Thng t s 10/2014/TT-BGDT ngy 11/4/2014 ca B trng B Gio dc v o to)

    Mu s 01: Bo co tin hc tp

    Mu s 02: n xin chuyn nc/trng/ngnh hc

    Mu s 03: n xin gia hn thi gian hc tp nc ngoi

    Mu s 04: Bo co tt nghip

    Mu s 05: n xin chuyn t trng hc nc ngoi v hc ti Vit Nam

    Mu s 06: Bo co thnh tch ca c nhn lu hc sinh

    Mu s 07: Bo co v vic tuyn sinh v c cng dn Vit Nam ra nc ngoi hc tp

    Mu s 08: Thng k s lng cng dn Vit Nam c c ra nc ngoi hc tp

    Mu s 09: Thng k danh sch cng dn Vit Nam c c ra nc ngoi hc tp.

  • 2

    Mu s 01 CNG HA X HI CH NGHA VIT NAM

    c lp - T do - Hnh phc

    BO CO TIN HC TP

    (t ngy ... thng ... nm ............ n ngy ... thng ... nm............)

    Knh gi: ....................................................1

    1. H v tn: ....................................................... Nam/n: ..................................................

    2. Ngy sinh: ......................................................................................................................

    3. Dn tc: .......................................................... Tn gio: .................................................

    4. Nm trng tuyn (i vi lu hc sinh hc bng):. Nm i hc: ..................

    5. a ch ni ti Vit Nam: .............................................................................................

    6. C quan cng tc (nu c): ..............................................................................................

    ............................................................................................................................................

    7. Din hc bng (Hip nh/NSNN/Khc, ghi c th):................................................... ......

    8. Ngnh hc nc ngoi (ghi ting Vit v ting Anh):

    ............................................................................................................................................

    ............................................................................................................................................

    9. Tn v a ch trng hc nc ngoi (ghi ting Vit v ting Anh): ...........................

    ............................................................................................................................................

    ............................................................................................................................................

    10. Ngy n trng nhp hc: ............................................................................................

    11. Ngy bt u kha hc (theo thng bo ca trng): .....................................................

    12. Thi gian o to (theo thng bo ca trng): .............................................................

    13. ang hc hc k my, thi gian cn li: ........................................................................

    14. a ch ni nc ngoi: .............................................................................................

    15. E-mail nc ngoi: .....................................................................................................

    16. in thoi lin h nc ngoi: ....................................................................................

    17. Kt qu hc tp 2: .........................................................................................................

    (Vit theo xp loi, nu c; hoc s mn t im A, im B, im C... hoc theo cch cho im ca trng n hc; i vi nghin cu sinh, thc tp sinh ghi xp loi kt qu): ...................................................................................................................................

    ............................................................................................................................................

    ............................................................................................................................................

    18. H tn ngi hng dn (supervisor) hoc ngi t vn (adviser): ...............................

    a ch e-mail ca ngi hng dn/t vn: .......................................................................

    1 Tn c quan c i hc. 2 i vi lu hc sinh hc bng: Ghi thng tin y lm cn c tip tc hoc tm dng cp sinh hot

    ph.

  • 3

    19. Kin ngh, xut (nu c): ...........................................................................................

    ............................................................................................................................................

    20. ngh cp hc ph, sinh hot ph (i vi lu hc sinh hc bng): ..............................

    ngh chuyn hc ph (theo giy bo ca trng) lu hc sinh cp nht thng tin ti khon ca trng theo chi tit sau:

    - Tn ngn hng

    - a ch ngn hng - M s ngn hng (nh

    Swift, Code, hoc ABA/Routing)

    - Thng tin ngn hng

    trung gian (nu c)

    - Tn ngi hng (tn ch ti khon ca c s gio dc) - a ch ngi hng

    - S ti khon - S Iban (nu c)

    nhn sinh hot ph n ht thng ...... nm ......

    Hc k cui cng xin c chuyn sinh hot ph n thng........ nm ......., Tng s ...... thng.

    Cp nht s ti khon c nhn ng k: 3

    - Tn ngn hng

    - a ch ngn hng - M s ngn hng (nh

    Swift, Code hoc ABA/ Routing)

    - Thng tin ngn hng

    trung gian (nu c)

    - Tn ngi hng (tn ch ti khon c nhn)

    - a ch ngi hng

    - S ti khon - S Iban (nu c)

    Xc nhn ca c s gio dc 4 ., ngy thng nm

    Ngi bo co

    (K v ghi r h tn)

    3 Ghi tn ngi hng theo tn ti khon m ti ngn hng v a ch ngn hng. Lu hc sinh chu mi chi ph

    lin quan trong trng hp cung cp thng tin chuyn tin khng chnh xc. 4 nhn c xc nhn ca c s gio dc nc ngoi LHS c th vit bo co bng ting Anh (bo co di

    hn 01 trang th cn c ch k/du gip lai xc nhn trn tt c cc trang ca bo co). Nu khng c xc nhn ca c s gio dc trn bo co th phi gi km theo kt qu hc tp c xc nhn ca c s gio dc.

  • 4

    Mu s 02

    CNG HA X HI CH NGHA VIT NAM

    c lp - T do - Hnh phc

    N XIN CHUYN NC/TRNG/NGNH HC

    Knh gi: ..........................................1

    Ti tn l: .........................................................................................................................

    C quan ch qun: ............................................................................................................

    ..........................................................................................................................................

    c c i hc nc ngoi theo Quyt nh s . ngy . thng ..... nm. ca..............................................................................................................

    C s gio dc tip nhn/ang hc: ..............................................................................

    Trnh o to: ..............................................................................................................

    Khoa: .............................................................. Chuyn ngnh: .........................................

    ..........................................................................................................................................

    Tng thi gian o to theo Quyt nh c i hc/ Vn bn tip nhn o to: ..................

    ..........................................................................................................................................

    Ngy nhp hc: .................................................................................................................

    Kt qu hc tp n thi im hin ti: .............................................................................

    Ni dung xin chuyn nc/trng/ngnh hc: ...................................................................

    ..........................................................................................................................................

    Vn bn ng tip nhn/i ngnh hc s........ ngy ..... thng .... nm ca ...................

    ..........................................................................................................................................

    L do xin chuyn nc/trng/ngnh hc: ........................................................................

    ..........................................................................................................................................

    ..........................................................................................................................................

    Ti cam kt t tc mi chi ph pht sinh t vic xin chuyn nc/trng/ngnh hc vt mc quy nh i vi vic i hc theo Quyt nh c i hc ti c s gio dc ban u.

    Trn trng ngh Qu c quan xem xt, cho ti c chuyn nc/trng/ngnh hc.

    a ch lin lc ca ti: ..............................................................................................

    ..................................................................................................................................

    E-mail: .....................................................................................................................

    in thoi nh: ...................................... in thoi di ng: ..................................

    ..........., ngy ... thng ... nm .........

    Ngi lm n

    (K v ghi r h tn)

    1 Tn c quan c i hc

  • 5

    Mu s 03

    CNG HA X HI CH NGHA VIT NAM

    c lp - T do - Hnh phc

    N XIN GIA HN THI GIAN HC TP NC NGOI

    Knh gi: ..........................................1

    Ti tn l: .........................................................................................................................

    C quan ch qun: ............................................................................................................

    ..........................................................................................................................................

    c c i hc nc ngoi theo Quyt nh s . ngy . thng ..... nm ca ...........

    Tn trng n hc, nc: ................................................................................................

    Trnh o to: ..............................................................................................................

    Khoa: .............................................................. Chuyn ngnh: .........................................

    Tng thi gian o to theo Quyt nh c i hc/ Vn bn tip nhn o to: .................

    Ngy nhp hc: .................................................................................................................

    L do xin gia hn: .............................................................................................................

    ..........................................................................................................................................

    ..........................................................................................................................................

    ..........................................................................................................................................

    ..........................................................................................................................................

    Thi gian xin gia hn : t thng ....../nm 20...... n thng ...../nm 20....

    Kinh ph trong thi gian gia hn: 2 ....................................................................................

    ..........................................................................................................................................

    Trn trng ngh Qu c quan xem xt, cho ti c gia hn thi gian hc tp.

    a ch lin lc ca ti: ..............................................................................................

    ..................................................................................................................................

    E-mail: .....................................................................................................................

    in thoi nh: ...................................... in thoi di ng: ..................................

    ..........., ngy ... thng ... nm ......... Ngi lm n

    (K v ghi r h tn)

    1 Tn c quan c i hc. 2 Ghi r kinh ph do lu hc sinh t thu xp hoc c s gio dc nc ngoi i th.

  • 6

    Mu 04

    CNG HA X HI CH NGHA VIT NAM

    c lp - T do - Hnh phc

    BO CO TT NGHIP

    Knh gi: ................................1

    1. H v tn: .....................................................................................................................

    2. Ngy sinh: ....................................................................................................................

    3. C quan ch qun: ........................................................................................................

    4. a ch c tr .................................................................................................................

    5. Quyt nh c i hc s .ngy .... thng .... nm .... ca .....................................

    6. Thi gian hc tp nc ngoi: ....................................................................................

    7. Thi gian gia hn hc tp nc ngoi: t thng / 20. n thng /20 .................

    8. Ngy tt nghip: ...................................................... Ngy v nc: ............................

    9. Kt qu hc tp 2:

    - Vn bng c cp: ....................................................................................................

    - Kt qu xp loi hc tp: ............................................................................................

    10. Tn c s gio dc nc ngoi (ghi bng ting Vit v ting Anh): ............................

    ..........................................................................................................................................

    11. Tn ti lun vn thc s (nu hc thc s coursework khng c lun vn th ghi: khng c lun vn), ti lun n tin s, chuyn thc tp: ..........................................

    ..........................................................................................................................................

    ..........................................................................................................................................

    12. Tn v hc hm, hc v ca ngi hng dn: ............................................................

    13. nh gi ca c s gio dc hoc gio s hng dn (nu c, vit tm tt): ...............

    ..........................................................................................................................................

    ..........................................................................................................................................

    14. T nh gi kt qu hc tp, nghin cu: ....................................................................

    ..........................................................................................................................................

    ..................................................................................... ....................................................

    15. Nguyn vng, ngh 3 : .............................................................................................

    ..........................................................................................................................................

    ..........................................................................................................................................

    16. C quan cng tc sau khi tt nghip v Vit Nam: ......................................................

    ..........................................................................................................................................

    a ch: .............................................................................................................................

    1 Tn c quan c i hc.

    2 Ghi r vn bng c cp (thng tin ny bt buc phi c), nu cha c bng tt nghip th phi trnh by r l do;

    ghi r kt qu xp loi hc tp (nu c); hoc s mn t im A, im B, C, hoc theo cch cho im ca c s

    gio dc. 3 Ghi r: Tr li c quan c hoc b tr ni lm vic hoc cng vic mi ph hp hn vi kt qu c o to;

    ng thi nu r vn hoc cng trnh kin ngh c ng dng, kh nng ng dng, yu cu c hc tp bi

    dng thm, yu cu v iu kin lm vic trong nc,

  • 7

    17. a ch lin h 4 : ........................................................................................................

    in thoi c nh: .......................................... , in thoi di ng: ...............................

    E-mail: ..............................................................................................................................

    18. Kin ngh, xut i vi cc c quan ch qun, c quan c i hc: ..........................

    ..........................................................................................................................................

    ..........................................................................................................................................

    Ti cam oan ni dung bo co l hon ton trung thc, chnh xc v xin chu trch nhim v ni dung bo co.

    , ngy thng nm ...

    Ngi bo co

    (K v ghi r h tn)

    4 Thng tin bt buc phi cung cp.

  • 8

    Mu s 05

    CNG HA X HI CH NGHA VIT NAM

    c lp - T do - Hnh phc

    N XIN CHUYN T TRNG HC NC NGOI V HC TI VIT NAM

    Knh gi: Trng/Hc vin1

    Ti tn l: ......................................................... Nam/n: ...............................................

    Ngy sinh: ........................................................................................................................

    c c i hc nc ngoi theo Quyt nh (nu c) s ............. ngy ...... thng ... nm .. ca 2 .................. ...............................................................

    Tn trng n hc: ................................................... ........................................................

    Trnh o to: ............................. ..................................................................................

    Khoa: ........................................................... Chuyn ngnh: ............................................

    Tng thi gian o to theo Quyt nh c i hc/Vn bn tip nhn: ...............................

    Ngy nhp hc: ..................................................................................................................

    L do xin chuyn t trng nc ngoi v hc tp Vit Nam: ...........................................

    ..........................................................................................................................................

    ..........................................................................................................................................

    ..........................................................................................................................................

    ..........................................................................................................................................

    Trn trng ngh Trng/Hc vin .................................................................................

    . xem xt, cho ti c chuyn v Qu trng tip tc hc tp.

    a ch lin lc ca ti: ..............................................................................................

    ..................................................................................................................................

    E-mail: ......................................................................................................................

    in thoi nh: ...................................... in thoi di ng: ...................................

    ..........., ngy ... thng ... nm ......

    Ngi lm n

    (K v ghi r h tn)

    H s 3 gi km theo gm: 1. 2. 3.

    1 Ghi tn c s gio dc m lu hc sinh xin chuyn n tip tc hc tp.

    2 i vi lu hc sinh hc bng. 3 Danh mc cc giy t trong H s c quy nh ti im b) khon 3 iu 10 ca Quy ch ny.

  • 9

    Mu s 06

    CNG HA X HI CH NGHA VIT NAM

    c lp - T do - Hnh phc

    BO CO THNH TCH C NHN LU HC SINH NGH TNG BNG KHEN/GIY KHEN

    1

    I. S LC L LCH

    - H v tn (Ghi y bng ch in thng, khng vit tt): ..................................

    - Ngy sinh: ................................................................. Gii tnh: ...........................

    - Qu qun: .................................................... ............. ..........................................

    - C quan ch qun: ..................................................... ..........................................

    - C quan c i hc: ..................................................... ..........................................

    - in thoi: ................................................................. E-mail: ..............................

    - Chc v (ng, chnh quyn, on th): ...............................................................

    - Trnh chuyn mn, nghip v: .........................................................................

    - Hc hm, hc v, danh hiu, gii thng: ..............................................................

    II. THNH TCH T C 1. Quyn hn, nhim v c giao hoc m nhn: ...............................................................................................................................

    ...............................................................................................................................

    ...............................................................................................................................

    2. Thnh tch t c ca c nhn: ...............................................................................................................................

    ...............................................................................................................................

    ...............................................................................................................................

    III. CC HNH THC C KHEN THNG 1. Danh hiu thi ua:

    Nm Danh hiu thi ua

    S, ngy, thng, nm ca Quyt nh cng nhn danh hiu thi ua; c quan ban hnh Quyt nh

    2. Hnh thc khen thng:

    Nm Hnh thc khen thng

    S, ngy, thng, nm ca Quyt nh khen thng; c quan ban hnh Quyt nh

    ..........., ngy ... thng ... nm .......

    CC O TO VI NC NGOI XC

    NHN, NGH (K, ng du)

    Ngi bo co (K, ghi r h v tn)

    1 ngh ghi r hnh thc ngh khen thng: Bng khen ca B trng B Gio dc v o to hoc Giy khen ca Cc trng Cc o to vi nc ngoi.

  • 10

    Mu s 07

    TN CQ, TC CH QUN 1 TN C QUAN, T CHC 2

    S: /BC-..... 3

    CNG HA X HI CH NGHA VIT NAM

    c lp - T do - Hnh phc

    ........., ngy ... thng ... nm ......

    BO CO

    V vic tuyn sinh v c cng dn Vit Nam ra nc ngoi hc tp

    Cn c Quyt nh s 05/2013/Q-TTg ngy 15 thng 01 nm 2013 ca Th tng Chnh ph quy nh vic cng dn Vit Nam ra nc ngoi hc tp, Thng t s 10/2014/TT-BGDT ngy 11 thng 4 nm 2014 ca B trng B Gio dc v o to hng dn cng tc qun lu hc sinh Vit Nam hc tp nc ngoi, ........4 bo co v vic tuyn sinh v c cng dn Vit Nam ra nc ngoi hc tp nh sau:

    1. Tnh hnh chung v cng tc tuyn sinh v s lng c cng dn Vit Nam ra nc ngoi hc tp 5: ........................................................................................................

    ..........................................................................................................................................

    ..........................................................................................................................................

    2. Nhng kh khn vng mc:

    ..........................................................................................................................................

    ..........................................................................................................................................

    ..........................................................................................................................................

    3. Kin ngh xut:

    ..........................................................................................................................................

    ..........................................................................................................................................

    ..........................................................................................................................................

    Trn trng /.

    Ni nhn: - ...... ; - ...... ;

    - Lu: VT, ...

    TH TRNG C QUAN/T CHC

    (Ch k, du)

    H v tn

    Ghi ch: 1 Tn c quan, t chc ch qun trc tip (nu c). 2 Tn c quan, t chc ban hnh vn bn.

    3 Ch vit tt tn c quan, t chc hoc chc danh nh nc ban hnh vn bn. 4 Tn c quan/t chc bo co.

    5 Km theo bo co chi tit theo Mu s 08 v 09 ti Ph lc ban hnh km theo Quy ch ny.

  • 11

    Mu s 08 TN CQ, TC CH QUN 1

    TN C QUAN, T CHC 2 CNG HA X HI CH NGHA VIT NAM

    c lp - T do - Hnh phc

    THNG K S LNG CNG DN VIT NAM C C RA NC NGOI HC TP NM .... (*)

    (Km theo Bo co s /BC-...... ngy ... thng ... nm ......)

    STT Ngnh c i hc3 Nc

    Trnh

    ang hc

    Hon

    thnh

    kha hc v nc

    V nc nhng

    khng hon

    thnh kha

    hc

    Ngun kinh ph

    4

    Ghi ch

    Tin s Thc s i hc Cao

    ng Bi

    dng Khc

    Tng s 5:

    TH TRNG C QUAN/T CHC

    (Ch k, du)

    H v tn

    Ghi ch: (*) Lp biu trn Microsoft Excel, phng ch Times New Roman, c ch 12 trn cng 1 file gm cc biu khc nhau v gi file vo a ch: [email protected].

    1 Tn c quan, t chc ch qun trc tip (nu c). 2 Tn c quan, t chc ban hnh vn bn. 3 Tham kho nhm ngnh hc quy nh ti Quyt nh 38/2009/Q-TTg ngy 09/03/2009 ca Th tng quyt nh ban hnh Bng danh mc gio dc, o to ca h thng gio dc quc dn.

    4 Ghi r lu hc sinh i bng ngun kinh ph no: hc bng ngn sch nh nc (NSNN) trung ng hoc a phng, hc bng Hip nh ca nc ngoi cp cho Vit Nam, hc bng ca nc ngoi (HBNN), t tc (TT), 5 Tng s ngi ang hc tp theo tng trnh , ang hc, v nc do c quan c i.

  • 12

    Mu s 09 TN CQ, TC CH QUN 1

    TN C QUAN, T CHC 2 CNG HA X HI CH NGHA VIT NAM

    c lp - T do - Hnh phc

    THNG K DANH SCH CNG DN VIT NAM C C RA NC NGOI HC TP NM ..... (*)

    (Km theo Bo co s /BC-...... ngy ... thng ... nm .......)

    STT H v tn Gii tnh

    Ngy

    sinh

    S h chiu

    C quan cng tc/ a ch thng tr

    Nc n hc

    C s gio dc n hc

    Trnh o to 3

    Ngnh hc 4 Thi gian bt u - Kt thc

    Ngun kinh ph

    5

    Ghi ch

    Tng s: ... ngi.

    TH TRNG C QUAN/T CHC (Ch k, du)

    H v tn

    Ghi ch: (*) Lp biu trn Microsoft Excel, phng ch Times New Roman, c ch 12 trn cng 1 file gm cc biu khc nhau v gi file vo a ch: [email protected]. 1 Tn c quan, t chc ch qun trc tip (nu c). 2 Tn c quan, t chc ban hnh vn bn. 3 Ghi r: Tin s (TS), thc s (Ths), i hc (H), cao ng (C), cao ng ngh (CN), trung cp ngh (TCN), trung cp chuyn nghip (TCCN), trung hc ph thng (THPT), trung hc c s

    (THCS), tiu hc (TH), thc tp sinh (TTS), bi dng (BD), khc. 4 Tham kho nhm ngnh hc quy nh ti Quyt nh 38/2009/Q-TTg ngy 09/03/2009 ca Th tng quyt nh ban hnh Bng danh mc gio dc, o to ca h thng gio dc quc dn.

    5 Ghi r lu hc sinh i bng ngun kinh ph: ngn sch nh nc theo cc n (ghi r s n v d: 322, 911, 165 ), hc bng Hip nh (H), hc bng ca nc ngoi (HBNN), t tc (TT).