Application for International Student’s Status Change at CPU

中国药科大学留学生学籍异动申请表
CN Name Gender Nationality
曼妮丝 Female Indonesia
中文名 性别 国籍
International
Student ID Major Degree
2620200113 economic Bachelor
学号 专业 学生类别
and trade

The reason I resigned was because of a heavy family reason that

allowed me to study there and financial reasons because I couldn't afford
Reasons/事由 to pay for college fully, my father still had to pay for my sister who was
still studying. so I decided to drop out. I'm sorry because I'm not optimal
in studying on campus

曼妮丝 Application Date 20 July 2021

Supervisor or Class Mentor

导师/班主任意见
Signature/负责人签字 （Stamp/部门盖章） Date/日期
University Outpatient
Complex

医务科意见
（Only for resumption and
suspension due to
sickness） Signature/负责人签字 （Stamp/部门盖章） Date/日期

（此项适用复学及因病休
学）

School of International
Education

国际教育学院意见
Signature/负责人签字 （Stamp/部门盖章） Date/日期

School/Department

院部意见（已知晓）
Signature/负责人签字 （Stamp/部门盖章） Date/日期
Suspension/休学□ From to ; signature：

备注：（请将异动类别涂 Dropout/退学□ signature：

黑，并签字。） Resumption/复学□ signature：
Student please shade the
Transfer/转学（专业）□ signature：
box and sign your name.
Extension/延期□ From to signature：
 Repetition/留级□ From to ; signature：

填写说明 Instructions：
1. 凡因病休学、复学、退学均需附三甲医院的诊断证明。Letter from a Chinese 3A hospital is
required for suspension, resumption and dropout caused by illnesses.
2. 此表须打印一式 3 份:国际教育学院 1 份，院部 1 份,学生 1 份。This form should be
completed in triplicate: for the School of International Education, for School and the
student.