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1、國立中央大學學生休學申請表國立中央大學學生休學申請表 NCU Application Form for Suspension _學年度 Academic year_學期 Semester學生姓名 Name學號 Student ID No.系所 Department年級 Grade列入休學年限Within the time-limit of suspension： 經濟不佳Financial Shortage 論文蒐集Thesis Research 成績考量Grading Cause 教師實習Teaching Intern生病Illness 工作Occupation 其他Others(勾選其他者
2、請列舉具體事實) (Please indicate the specific reason)申請休 學理由 Reasons不列入休學年限 Without the time-limit of suspension： 服兵役Military Service 懷孕Pregnancy 育嬰Child Nurture證明 文件 Verifying Documents區域醫院診斷書 Medical evidence 兵役證件影印本 Copies of military service certificates 其他Others（ ）休學期間 Period of Suspension申請於 學年度第 學期
3、至 學年度第 學期止 From the _semester of academic year_ to the _semester of academic year_共休學 期數Total semesters of Suspension一學期One semester 二學期Two semesters 三學期Three semesters 四學期Four semesters 復學通知 寄達地址 Mailing address（請正楷詳細填寫 Please write in regular script）電話 Phone Number申請人 Applicant同意I agree 不同意I dont
4、agree 本弟子辦理休學my son/daughters application 學生家長Students parents：年 月 日（簽章）Year month day (signature/seal)學生Student：年 月 日（簽章）Year month day(signature/seal) 教學單位 Department/College行政單位 Administrative Offices導師/指導老師 Advisor系主任/所長 Chairperson院長 Dean註冊組經辦 Section of Registry註冊組組長 Registrar教務長(或授權人) Dean of
5、 Academic Affairs核准 Ratification簽核順序Procedures and Instructions： 導師/指導老師系主任/所長院長生活輔導組/僑外輔導室/國際事務組註冊組經辦註冊組組長教務 長(或授權人) Advisor Chairperson of Dept. Dean Division of Student Conduct and Housing Service / Division of Overseas Chinese / 生活輔導組 Division of Student Conduct and Housing Service國際學生事務組 Divisi
6、on of International Student Affairs會簽 Countersign（僅僑生需辦理） For overseas Chinese students only 若請領教育部清寒助學金需歸還 Scholarship of MOE Return（僅外籍生需辦理） For foreign students onlyDivision of International Affairs Section of Registry Dean of Academic Affairs9903091.學生如因重病（持有健保局特約區域醫院證明書）或重要事故（附相關證明） ，經家長或監護人之同意
7、， 得申請休學。 Students under serious diseases (with medical evidence from NHI registered hospitals) or accidents (with proofs), with permissions from parents or guardians, are allowed to apply for suspension. 2.申請休學應另備離校申請表，依規定辦妥離校手續（續申請休學者免） ，並將學生證繳回註冊組。Students who apply for suspension should also fill
8、 out “NCU Application Form for Leaving School”, and return student ID card to Section of Registry. 3.因經濟不佳需休學者，請閱畢附件 1國立中央大學學生安定就學專案 ，並填妥下方回執聯，連同休學 申請表、離校申請表，一併送交註冊組辦理。 For students applying for suspension due to financial shortage, please finish reading the attachment of “NCU Studying Project for S
9、tudents with Financial Shortage” and fill out the reply form on the bottom page of it. Then submit the reply form along with the application forms of Suspension and Leaving School to the Section of Registry. 4.休學手續應於校曆明訂之學期考試前辦妥。 The procedure should be completed before the final exams of every seme
10、ster scheduled on the school calendar. 5.學生有下列情形之一者，應令休學： Suspension is advised under either one of the following conditions: (1) 學期中請假逾三分之一者； The nonattendance is over one third of the semester. (2) 患病經健保局特約區域醫院以上證明六週內難於痊癒者； Illness that cannot be recovered within six weeks under the Medical eviden
11、ce from NHI registered hospitals. 6.學生每次得申請休學一學期至二學年。休學累計以二學年為原則，期滿因重病或特殊事故等原因需再申 請休學者，得酌予延長休學一年，但在休學期間應徵服兵役者，需檢具在營服役證明，申請延長休學期 限，俟休學期滿檢送退伍令申請復學（服役期限不列入休學年限併計） ，期滿不復學者，以退學論。學生 因懷孕、生產、哺育三歲以下子女得檢具相關證明文件，申請休學，其休學期間不列入休學年限，合計 最多以四年為限。休學期滿，應檢附子女出生證明及相關證明文件申請復學。Students are able to apply suspension from o
12、ne to four semesters (two academic years) each time. The maximum of the accumulated suspension is two academic years. For those who apply for longer suspension due to serious illnesses or accidents, one additional academic year is allowed. For those who have military duty during suspension, the proo
13、f of discharge is required for resuming the schooling after the expiration of military service. (The duration of military service is not included in the period of suspension). If students do not apply for resumption after the suspension expires, they will be expelled. For those who apply for suspens
14、ion due to pregnancy, childbirth, nurture of child under age three, relevant document and certificate are required. The period of suspension due to the reasons above will not be counted in the period of suspension, and the maximum of total period is four years. When the period of suspension expires,
15、 birth certificate and relative documents are required for school resumption. 7.休學期限屆滿前一個月，應自行向教務處申請復學，期滿不復學者，以退學論。 Students should apply for school resumption one month before the suspension expires, if students do not apply for resumption at the due time, they will be expelled. 8.逾期未註冊，亦未於規定期間請准休學
16、者，應令退學。 Students will be expelled if they neither complete the procedure of registration nor apply for the suspension at the due time. 9.休學如合於退費規定者，於核准休學後十日內向註冊組辦理退費手續。 If students suspension is qualified to receive refund according to the regulation, they may transact the refund procedure at Section of Registry within ten days after the suspension is ratifie
