中文姓名：           

Name：              

男M □

女F □

□进修生General Student

□本科生Undergraduate

□硕士研究生Postgraduate

□博士研究生Doctoral Student

请假时间Leave Duration：

自From        /     /     (YYYY/MM/DD)

至To          /     /     (YYYY/MM/DD)

请假期间联系方式

Contact phone number during the leave：

说明：1.除请假收集论文数据外，其他任何原因请假均不补发生活费；

      2.请假满两周扣发半个月生活费，请假超过两周扣发请假期间全部生活费；

      3.返校后提交经导师签字的数据收集报告，国际学院审核后，方可补发生活费；

      4.原则上，最长请假期限为三个月。

Note：1.Except for leave taken to collect thesis data, living allowances will not be reissued for leave taken for any other reason.

2.If leave lasts two full weeks, half a month’s living allowance will be deducted. If leave exceeds two weeks, the entire living allowance for the leave period will be withheld.

3.After returning to campus, students need to submit a data collection report signed by their supervisor. The living allowance will only be reissued after the report is reviewed and approved by the International College.

4.In principle, the maximum leave period is three months.

我已悉知并同意以上内容。

I hereby acknowledge and agree to the above terms and conditions.

签名Signature:　　　　　     日期Date:       /     /     (YYYY/MM/DD)

请假原因Reason：

签名Signature:　　　　　     日期Date:       /     /     (YYYY/MM/DD)

注：实习、调研需同时提交实习、调研计划（导师签字，盖学院印章），参加活动需提供组织方出具的证明或邀请。

Tips: For internship and research, corresponding schedule is required (with signature of supervisor and college stamp). For activities, official certificate or invitation letter of the organizing institution is needed.

导师/班主任意见Opinion of Supervisor(Head teacher)

签名Signature:　　　　　     日期Date:       /     /     (YYYY/MM/DD)

所在学院意见Opinion of the College

签名Signature:　　　　　     日期Date:       /     /     (YYYY/MM/DD)

盖章 Official Stamp

国际学院意见Opinion of the International College

签名Signature:　　　　　     日期Date:       /     /     (YYYY/MM/DD)

盖章 Official Stamp