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國立陽明交通大學學務處住宿服務組

Housing Center, Office of student Affairs , National Yang Ming Chiao Tung University

109學年度第2學期退宿申請

申請109學年度第2學期退宿請填寫本表單
(Please complete this form to apply for a 2nd semester withdrawal for the 109th academic year)

請依序完成以下手續:
(Please complete the following procedures in order)

1. 請先至男一或男五舍管理員室辦理遷出手續
(Please go to the Male 1 or Male 5 warden's office to complete the moving out procedure.)

2. 填寫本表單
(Fill in this form)

3. 依本組退費時程至住輔組填寫退費表格,退費所需附件請上本組網頁查詢

    本份資料僅做退費用途,不會挪作他用。
(Complete the refund form at the Residence Support Section according to the Section's refund schedule.

This information is for refund purposes only and will not be used for other purposes.)
*學號School Number:
*姓名Name:
*系所Department:
*性別Gender:
男(MALE) 
女(FEMALE) 
109住宿舍別109 Residence:
男一舍(MALE DORM#1) 
男二舍(MALE DORM#2) 
男三舍(MALE DORM#3) 
男五舍(MALE DORM#5) 
女一舍(FEMALE DORM#1) 
女二舍(FEMALE DORM#2) 
女三舍(FEMALE DORM#3) 
女五舍(FEMALE DORM#5) 
109寢室號碼,請填四碼(例:2301)109 Dormitory Number, please fill in the 4-digit number:
*退宿原因Reason for withdrawal:
畢業(Graduation) 
休學(Suspension of Studies) 
退學(Withdrawal) 
校外租屋(Off-campus rentals) 
放棄抽籤(Give up the lottery) 
其他原因(請填寫於下一題)(other) 
其他退宿說明Other reasons for withdrawal:
*手機Mobile Phone:
實驗室分機Laboratory extension:
*E-mail:
*是否辦理就學貸款Whether you are applying for a student loan:
是(YES) 
否(NOT) 
*身分證字號Identity Card Number:
*申請日期Application Date: Calendar
*上傳學生證Upload Student Card:
備註Remark:
*
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