国际学生换宿舍申请表
Application Form of Changing Dormitory for International Students
姓名 Name |
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护照号码Passport No. |
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性别 Gender |
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国籍 Nationality |
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出生日期 Date of Birth |
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班级 Class |
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电话 Mobile |
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学号 Student No. |
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电子邮箱 E-mail |
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宗教信仰 Religious belief |
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原宿舍信息 Original Dorm |
楼栋Building NO.：______ 房间号Room NO.：______ |
拟调宿舍信息 New Dorm |
楼栋Building NO.：______ 房间号Room NO.：______ |
换宿舍理由 Students Reasons |
（详细说明，如室友作息、学习需求、身体原因等；此处写不开，可附页）Insufficient space here; please refer to the attached page 签名Signature 日期Date |
辅导员复核审批 Counselor review and approval |
签名Signature 日期Date |
留学生后勤服务中心意见 Opinions of Dormitory Office |
签名Signature 日期Date |
学院审核 College Review |
□ 同意agree □ 不同意disagree 原因reason： 盖章： |
调宿生效日期 Effective Date |
年 月 日 YYYY/MM/DD |
承诺与声明
Commitment & Declaration
本人已阅读并知晓《山东第一医科大学国际学生公寓管理规定》，承诺在调宿获批后3 日内完成搬迁，清空原宿舍个人物品，配合宿管检查设施；按时缴纳新宿舍住宿费及水电费；服从学校统一安排，不私自换宿。如有违反，自愿接受学校处理。
I have read and understood the Regulations on the Administration of International Student Apartments of Shandong First Medical University. I promise to complete the move and clear all personal belongings from the original dormitory within 3 days after my room change application is approved, and cooperate with the dormitory management in facility inspections.
I will pay the accommodation fee and utilities for the new dormitory on time, obey the university’s unified arrangements, and shall not change dormitories without permission. If I violate any of the above terms, I voluntarily accept corresponding disciplinary measures imposed by the university.
本人签名（Student Signature）：__________
日期（Date）：__________
备注Note：
1.每年三月份仅有一次机会换宿舍，但必须提交书面申请，写清楚换宿舍的理由。理由必须充分，并提供相关证明。There is only one opportunity to change dormitories in March each year, but a written application must be submitted clearly stating the reasons for changing dormitories. The reasons must be sufficient and relevant evidence must be provided.
2.流程结束后，此表由公寓值班室留存备查。After the process is completed, this form shall be retained by the apartment duty room for reference.
3.如遇特殊情况，可以由学生提出申请，学院审批执行。If special circumstances arise, students may submit an application, which will be implemented after approval by the college.
