中国科学院西双版纳热带植物园疫情期间研究生离园审批表.docx

中国科学院西双版纳热带植物园 疫情期间研究生离园审批表 Application Form of XTBG Student for Leaving 姓名 Name 性别 Gender 学号 Student ID 导师 Supervisor 途径或停留地点 Passage or Stay Place 去程信息 （航班号/列车号） Departure information (Flight No./Train No.) 途径或停留地 点是否为中高 风险地区 Whether the passage or stay place is a medium or high risk area 请假人电话 Personal Phone 家庭电话 Home Phone 离园事由 Reasons For Leave 离园时间 Date From 导师意见 Supervisor’ s Comment 研究生处意见 Office of Graduate Affairs’ Comment 学生本人签字 Student's signature 返园时间 Date To 签字/Signature: _______ 日期/Date ____年/Year ___月/Month ___日/Day 签字/Signature: _______ 日期/Date ____年/Year ___月/Month ___日/Day I understand that the current epidemic situation is unstable. After I go out, if there is any situation, I will be responsible for the consequences. 签字/Signature: _______ 日期/Date ____年/Year ___月/Month ___日/Day