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 sinh vin:.........................................................................................................................
H khu thng tr (ghi y ):............................................................................................................
X (Phng):...................................... Huyn (Qun):............................................................................
Tnh (Thnh ph):....................................................................................................................................
S in thoi lin lc khi cn: Ca SV:.................................Ca gia nh SV:......................................
Thuc i tng (ghi r i tng c quy nh ti Thng t lin tch 29/2010/TTLT-BGD&TBTC-BLTBXH ngy 15 thng 11 nm 2010): ......................................................................................
..................................................................................................................................................................
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:
(K v ghi r h tn)

Xc nhn ca Trng i hc Bch khoa i hc Quc gia Thnh ph H Ch Minh:

Anh/ ch:...................................................................................................................................................
Hin l sinh vin nm th:. Hc k: Nm hc: 20 - 20 .Lp: .
Khoa: .. Ngnh: Kha hc: 20 . Thi
gian kha hc: nm H o to: .ca nh trng.
K lut:.....................................................................................................................................................
S tin hc ph hng thng: ......................................................ng
(Ghi bng ch: .....................................................................................................................................)
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.
Tp. H Ch Minh, ngy thng nm 20
TL. HIU TRNG
TRNG PHNG CTCT-SV

ThS. V Tn Thng