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班级：                                  姓名：                             学号                                 

请假事由：                                                                                             

请假起止时间：                                                                                      

班主任意见：                                                        签名：                    年  月  日

系书记意见：                                                        签名：                    年  月  日

学生处意见：                                                        签名：                    年  月  日

销假时间：                                                                                                 

西安医学院学生请假条

班级：                                   姓名：                               学号                              

请假事由：                                                                                                  

班主任意见：                                                            签名：                 年  月  日

系书记意见：                                                            签名：                 年  月  日

学生处意见：                                                            签名：                 年  月  日

销假时间：