傳染病疑似個案回校上課切結書
學生
（學號：
）目前就讀
系
年
班，同意上課期間遵循醫囑，
完成療程及用藥。如經查未遵循醫囑完成療程，本校將依學則（義守大學學則第十
九條第三款）逕行處分。
此致
義守大學
學生
中
華
民
國
年
（簽章）
月
日
Affidavit for the Student who is Suspected of Suffering from an
Infectious Disease and Wish to Return to ISU
I,
, whose student number is
, and is presently enrolled at
(Class/ Year/
Department), hereby agree that I will take medicine and receive medical treatment as prescribed by the
doctor while studying at ISU. If I am found having not followed the doctor’s instructions to take medicine
or receive necessary medical treatment, I shall be punished by ISU according to Subparagraph 3 of
Article 19 of Academic Rules of I-Shou University without any disagreement.
Note: In the event of any disputes or misunderstanding as to the interpretation of the language or terms of
this Affidavit, the Chinese language version shall prevail.
To
I-Shou University
Signature:
Date:
/
/
/(Y/M/D)