國立中央大學學生休學申請表

國立中央大學學生休學離校手續申請表

NCU Application Form for Suspension of Schooling

學生姓名 Name

學號 Student ID No.

系所 Department/ Institute

年級 Grade

申請休 學理由 (僅擇一) Reasons (Choose only one reason.)

列入休學年限：The following reasons are included in the term limit of suspension:

□經濟困難Economic hardship □論文撰寫Writing the graduation thesis □教師實習Teacher Intern □傷病Injury or sickness □工作Occupation □出國Going abroad

□就讀學校、科系不符期待The student finds his/her university or department does not meet his/her expectation. □學業成績不佳Unsatisfactory academic performance □就學環境Educational environment □家務或家人照顧Dealing with family affairs or taking care of any family member □因考試訓練(含研究所、公職、就業、證照考試)Training for examinations

不列入休學年限(應附證明文件)：The period of the suspension will not be included in the time limit on study if you apply for suspension of schooling for any of the following reasons (documentation should be attached): □兵役Military Service □懷孕Pregnancy □育嬰Child Nurture

休學期間 Period of Suspension

申請於學年度第學期至學年度第學期止 From the ______semester of academic year______ to the ______semester of academic year______

復學通知 寄達地址 Mailing address

電話 Phone Number

申請人 Applicant

學生家長簽章--同意本弟子辦理休學(研究生免)： Signature of the applicant’s parent, who approves this application of suspension of schooling (not applicable to postgraduates): 年月日Year month day

學生簽章： Student’s signature: 年月日 Year month day

核准 Ratification 及 日期 Date

1導師/指導老師 Advisor

2系所經辦 Clerk at the Department

3系(中心)主任/所長 Director of the Department/Center

5註冊組經辦 Division of Registrar

註冊組組長 Chief of the Division of Registrar

教務長(或授權人) Dean of Academic Affairs (or Deputy)

教務處註冊組為最後簽核單位

□註冊日（含）之前退還所繳各費。 □退還學雜費（或學分費、學雜費基數）及其餘各費總和之2/3。 □退還1/3。

4會簽單位：(申請時為在學生狀態者才須至會簽單位蓋章) 4.Countersign Units: (This step is required only if the applicant is still a student studying in school.)

體育室 Office of Physical Education

圖書館典閱組 Division of Collection and Circulation at the Library

國際事務處 Office of International Affairs

地點：依仁堂1樓 Location: Ground floor of Yi-ren Hall 大一新生開學日(含)前離校者免Freshmen who leave before (or on) the first day of school do not have to go through this step.

新生開學日(含)前離校者免Freshmen who leave before (or on) the first day of school do not have to go through this step. 清還借書與罰款請先上網查詢 Return books and pay fines. Please look up your record online in advance.

僅僑生、外籍生和陸生須辦理For overseas Chinese students, foreign students andMainland Chinese students only. 若僑生請領教育部清寒助學金者須歸還If an overseas Chinese student applying for suspension of schooling has been given a low-income household scholarship by the MOE, the student has to return the scholarship.

住宿服務組 Student Housing Service Division

系所實驗室 Labs

地點：國際學舍1樓 Location: Ground floor of International Student Dormitory 開學前離校者需補繳當月住宿費用，未住宿者則免。 One leaving before the first day of semester should pay the fee of the month.(only for the residents). 離校當學期有住宿者，須先完成退宿檢查手續。Residents need to finish the checkout procedure. 繳清修繕清潔成本費用，請至宿舍抽籤系統查詢。Look up the fine you have to pay online.

下列系所同學須辦理For students from the following departments only: 物理系Physics 化學系Chemistry 生命科學系Life Science 光電科學與工程學系Optics and Photonics 系統生物與生物資訊研究所Systems Biology and Bioinformatics 化學工程與材料工程學系Chemical and Materials Engineering 資訊工程學系Computer Science and Information Engineering 通訊工程學系Communication Engineering 水文與海洋科學研究所Hydrological andOceanic Sciences 環境工程研究所Environmental Engineering 企管系（研究生須辦理）Business Administration (for postgraduate students only) 財金系（碩博士生須辦理）Finance (for postgraduate students only)

簽核順序：

Procedures and Instructions:

1. 導師/指導老師→2. 系所經辦 →3. 系(中心)主任/所長→4. 會簽單位(申請時為在學生狀態者才需至會簽單位蓋章)→5. 註冊組經辦→註冊組組長→教務長(或授權人)

1. Advisor → 2. Clerk at the Department→ 3. Director of the Department/Center →4. Countersign Units (this step is required only if the applicant is still a student studying in school) →5. Division of Registrar→Chief of the Division of Registrar → Dean of Academic Affairs

1. 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，得申請休學。

Students havingserious diseases (with medical certificatesfrom NHI-contracted hospitals) or accidents (with proofs), with permissionsfrom parents or guardians, are allowed to apply for suspension of schooling.

2. 申請休學應填具「休學離校手續申請表」，依規定辦妥離校手續（續申請休學者免）。Students who apply for suspension of schooling should fill out “NCU Application Form for Suspension of Schooling”.

3. 休學手續應於校曆明訂之學期考試前辦妥。

The procedure should be completed by the final exams in every semester scheduled on the school calendar.

4. 學生有下列情形之一者，應令休學：

A student should be advised to suspend his or her schooling under either one of the following conditions:

1. 學期中請假逾三分之一者；

His or her 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；

His or her illness was proved unlikely to be cured within six weeks and the fact is specified in a medical certificate issued by an NHI-contracted hospital.

5. 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，經系（學位學程）主管及教務長同意，得酌予延長休學二年。學生休學期間結束應申請復學，期滿不復學者，以退學論。學生休學期間應徵服役者，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（服役期間不列入休學年限併計）。學生因懷孕、分娩或撫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。休學期滿，應檢附子女出生證明及相關證明文件申請復學。法令另有規定者，從其規定。

Students may apply for suspension of schooling for one semester to two academic years each time. The maximum of the cumulated period of suspension of schooling is two academic years. For the applicant who needs to apply for a longer period of suspension of schooling due to any serious illness or incident, an additional period of two more academic years can be allowed upon approval from the head of the applicant’s department (degree program) and the Vice President for Academic Affairs. When a student’s period of suspension of schooling ends, the student should apply for resumption of schooling. Those who fail to resume their schooling after their period of suspension of schooling ends will be forced to drop out. For those who are doing military service during the period of suspension of schooling, proof of serving in the army is required for extending the period of suspension of schooling. When their period of suspension of schooling expires, a Military Service Discharge Order is required for their application for resumption of schooling (the duration of their military service will not be included in their maximum cumulated period of suspension of schooling). Students who are pregnant, preparing for labor, or raising children under age three may apply for suspension of schooling with relevant documentation, and the duration of their suspension of schooling for these parental reasons will not be included in the maximum cumulated period of suspension of schooling. When their period of suspension of schooling expires, a birth certificate and relevant documentation are required for their application for resumption of schooling. Matters not provided for herein shall be governed by other applicable statutes.

6. 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 resumptionof studies one month before the suspension expires. If students do not apply for resumptionof studies in due time, they will be expelled.

7. 逾期未註冊，亦未於規定期間請准休學者，應令退學。

Students will be expelled if theyneither complete the procedure of registrationnor apply for the suspension of schooling in due time.

8. 休學如合於退費規定者，應主動向註冊組提出退費申請。

If a student’s suspension of schooling is qualified to arefund perrelevant regulations, he or sheshould activelyapply for a refundtothe Division of Registrar.

9. 休退學時間應依學生(或家長)向學校受理單位(系所)正式提出休退學申請之日為退費計算基準日。

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1120330

he date on which a student (or the student's parent) applies to his or her department/institute for suspension of schooling or withdrawal from school should be the date of reference that the calculation of a tuition refund is based on.