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中国矿业大学国际学生行程异动备案/申请表Application Formof Travellingout forInternational Students,CUMT中文名护照号联系方式Chinese NamePassport No.Phone Number护照名学号所在学院CollegeStudent1DPassport Name当前详细住址Current address目的地详细地址Detailed addressofdestinationInclude city,street,community androom number外出原因The reasonfor thetrip申请人签字年日Signature:Y MMD本人郑重承诺外出期间严格遵守属地疫情防控管理相关规定;自觉遵守交通法规,不去各类娱乐场所及酒吧、网吧等处活动;不酗酒,不涉毒,不参与各类赌博活动;按规定时间返校徐,如遇异常情况第一时间向辅导员报告I Promise:During travelingout,I willstrictly abidethe localrules and regulations ofepidemic prevention安全承诺and control;consciously abideby thetraffic lawsandregulationsand willnot goto entertainmentplaces andvariousbars;no excessivedrinking,no drugsand willnot joinin anygambling activities;return to thecampus Xuzhouin theregulated timeand reporttotheteacher inany unexpectedcases inthe firsttime.申请人签字年月日Signature:Y MD请写明机票及火车票等所有信息,包括时间,航班号,火车班次,机场及火车站等Please writeall theinformation aboutyour planetickets and train tickets,including thetime,flight number个人计划行程andtrainnumber,airport andrailway station.Itinerary ofthe出发时间Depart time______________________日D_______月Mround trip火车班次/航班号Train No./Flight No._______________________返回时间Return time_____________________日D_______月M火车班次/航班号Train No./Flight No._______________________经审核,同意该生外出申请,我单位将按照《中国矿业大学国际学生疫情防控期间管理办法(试行)》,严格规范学生外出期间管理指定责任联络人_____________________国际学院意见(含联系方式)Remarks fromInternationalCollege单位负责人签字(单位盖章)年月日。