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1、学号IDNo.中文名CNName英文名ENName年级Batch性别Gender国籍Nationality电话TelNo.电子邮箱Email实习单位InternshipHospital实习医院所在国家InternshipCountry实习期间InternshipDurationFromYYYY_MM_DDto_YYYY_MMDD请附住院相关材料。PIeaSeattachthebasicinformationOfthehospital.1 .本人回国实习的计划已告知我的父母和家人，并得到他们的同意与支持。定已充分考虑南京医科大学国际教育学院对于海外实习感染COVID-19风险的2 .Myfami
2、lymembersincludingmyparentshavebeeninformedthatIwillcompleteinternshipinmyowncountryandIhavebeenprovidedwiththeirsupport.Beforemadethisdecision,thewarningfromSIE,NMUhasbeenseriouslyconsideredthatCOVID-19infectionduringtheinternship.3 .本人将按照南京医科大学留学生实习大纲的要求完成实习，实习医院应具备完成大纲要求的硬件和师资要求，并被本国医学会认可。2.1 wil
3、lstrictlyabidebyeverytermoftheInternshipSyllabusinordertocompletemyinternshipinthehospitalwiththequalifiedequipmentsandteachersmatchingthecorrespondingrequirementsinInternshipSyllabus.ThehospitalshouldbeadmittedbythelocalcountrysMedicalCouncil.3.本人承诺将于20一年月日和20年月一日向学校提交实习情况报告。如预计超过一年未能完成临床实习，将于20年一月
4、日前提交延期实习申请。3.1 sincerelypledgethatIwillsubmitmyinternshipreporttoSIEon,2021and,20.IfIamunabletocompletetheinternshipwithinoneyear,IwillapplyforanextensionofinternshipBEFORE,204.本人将确保实习期间与南京医科大学国际教育学院的联系，如未能按期提交相关报告或失联，将自行承担应相应后果。本人已确认是否已全部通过以往课程情况，并已充分考虑可能产生的延期毕业后果。4.IsincerelypledgethatIW川keepintou
5、chwithSIEduringthe1-yearinternship.IshallbebearanyresponsibilityifIcannotsubmittheinternshipreportontimeorhavelostcontactwithSIE,NMU.Ihavecheckedwhetherhavepassedallthesubjectsbefore,andIhaveconsideredallthepossibilitiesmayhappen,includingextension.备注：如学生自应提交实习报告之日起10日内仍未与学院取得联系，学院将保留进一步追究直至取消该生学籍之权利。Note:TheSchoolofInternationalEducationremainstherighttocancelstudents*enrollmentstatusifsomeonehaslostcontactwithSIEwithin10daysfromthescheduledreportsubmissiondate.学生签名/StudentsSignature:日期/Date:父母签名/ParentsSignature:日期/Date:
