PH LC III

(Km theo Thng t lin tch s 29 /2010/TTLT-BGDT-BTC-BLTBXH ngy 15 thng 11 nm 2010 ca Lin B Gio
dc v o to, B Ti chnh v B Lao ng-Thng binh v X hi)

_________________________________________________________________________________

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
N NGH CP TIN H TR MIN, GIM HC PH
Knh gi: Phng Lao ng - Thng binh v X hi (cp huyn)
H v tn: .....................................................................................................................................
Ngy, thng, nm sinh:..................................................................................................................
Ni sinh:.......................................................................................................................................
H tn cha/m:..............................................................................................................................
H khu thng tr:.........................................X (Phng):.......................................................
Huyn (Qun): ........................................Tnh (Thnh ph) :.......................................................
Ngnh hc :..............................................M s sinh vin: .........................................................
Thuc i tng: Thng xuyn tip xc vi mn hnh, cng thng thn kinh, tm l theo mc
VIII.11 ca Quyt nh s 1453/LTBXH-Q ngy 13-10-1995 ca B trng B Lao ngThng binh v X hi.
Cn c vo Ngh nh s 49/2010/N-CP ngy 14 thng 5 nm 2010 ca Chnh ph, ti lm
n ny ngh c xem xt, gii quyt c cp tin h tr min, gim hc ph theo quy nh v
ch hin hnh.
Ngy .... thng .... nm ......
Ngi lm n

Xc nhn ca c s gio dc ngh nghip v gio dc i hc cng lp

Trng: i hc Cng ngh Thng tin i hc Quc Gia TP.HCM
Xc nhn anh/ch: ........................................................................................................................
Hin l sinh vin nm th ...... Hc k: ... Nm hc: .....................lp.....................................
khoa ....................................................................... kha hc......................................................
thi gian kha hc ti a 6 nm h o to chnh quy ca nh trng.
K lut: ........................................................................................................................................
S tin hc ph hng thng:................................ng/5 thng.
ngh Phng Lao ng - Thng binh v X hi xem xt gii quyt tin h tr min, gim
hc ph cho anh/ch ............................................................. theo quy nh v ch hin hnh.
Ngy ...... thng ..... nm ...........
TL.HIU TRNG
TRNG PHNG CNG TC SINH VIN