CNG HA X HI CH NGHA VIT NAM

c lp T do Hnh phc

ThS. V Tn Thng

N NGH CP TIN H TR MIN, GIM HC PH

HNG DN LM N:

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:..................................................................................................................................

Lu :
+ SV bt buc phi xut trnh KQKMH chnh thc hoc bin lai thu hc ph ca hc
k mun xc nhn km theo c khi np v khi nhn li n.
+ n ch c vit bng mc bt bi, mu xanh
+ Khng nhn n in sai theo hng dn, khng nhn n b bi xa hoc vit bng
bng hai mu mc tr ln.

H khu thng tr (ghi y ):.....................................................................................................................

X (Phng):.................................................................... Huyn (Qun):.......................................................

Phn mt:

Tnh (Thnh ph):.............................................................................................................................................

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&T-BTCBLTBXH 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)

H v tn: in bng ch in hoa. V d : NGUYN VN A

Ngy thng lm n, k tn: ghi r ngy thng lm n v k tn y
Cc ni dung khc ghi y .

Phn hai:

Anh/ ch: (ghi li h tn nh phn mt): NGUYN VN A

Hin l sinh vin nm th: ghi r rng c s v ch . V d: nm th 4 (bn).
Xc nhn ca Trng i hc Bch khoa i hc Quc gia Thnh ph H Ch Minh
Anh/ ch: ................................................................................................MSSV:..............................................
Hin l sinh vin nm th:. ... Hc k: Nm hc: 20 - 20 .Lp:

Hc k: 1 hoc 2 (khng ghi bng s La M)

Lp: ghi ng m lp ang hc. V d: HC07TP01
Khoa: ghi y , khng vit tt

Khoa: NgnhKha hc: 20 . Thi gian kha hc: nm

Ngnh: ghi y , khng vit tt (SV cha phn ngnh th b trng mc ny)

H o to: .ca nh trng.

Kha hc: ghi nm bt u hc hc k 1 nm nht

K lut:..............................................................................................................................................................

Thi gian kha hc: 4,5 nm i vi i hc v 03 nm i vi cao ng (ghi ng 4,5

S tin hc ph hng thng: .......................................................................................................ng

nm. Trng hp SV hc qu hn trn, lin h P.CTCT-SV lm n xc nhn ang hc ti

(Ghi
bng
ch:
........................................................................................................................................................................

trng np km theo mu n ny)

)
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

H o to: Chnh quy

K lut: ghi r mc k lut nu c, khng b k lut ghi khng
S tin hc ph hng thng: Ly s tin hc ph hc k xin c xc nhn c th hin
trong kt qu ng k mn hc chnh thc chia cho 5, lm trn n hng trm ng.
V d: hc ph th hin trong KQKMH l 2.254.000 ng.
S tin hc ph hng thng s l: 450.800 ng

...min gim hc ph cho anh/ ch: ghi li h tn bng ch hoa thng

Tp. H Ch Minh, ngy thng nm 20: