B GIO DC V O TO

TRNG I HC TY BC

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

N XIN TM DNG TIN HC TP

Knh gi : Ban Gim hiu Trng i hc Ty Bc
Ti tn l:. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .M s sinh vin :. . . . . . . . . . . . ..
Ngy sinh :. . . . . . . . . . . . . . . . . . . . .H khu thng tr (ghi chi tit a ch):. . . . . . . . . . . . . .
............................................................................
Hin

ang

hc

lp:.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kha : . . . . . . . . . . . . . . . . . . . .
Khoa: . . . . . . . . . . . . . . . . . . . . . . . . H o to: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ti lm n ny knh ngh Ban Gim hiu Trng i hc Ty Bc cho php ti
c bo lu kt qu hc tp ca hc k . . . nm hc . . . . . . . . . . . . . . . . . . . . v c tm
ngh hc ti Trng k t hc k . . . . nm hc . . . . . . . . . . . . . . . . . . . . n ht hc k . . . . . .
ca nm hc . . . . . . . . . . . . . . . . .
L do xin tm ngh: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....
. . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rt mong c s ng ca Ban Gim hiu!
KIN CA GIO VIN CH NHIM

KIN CA BCN KHOA

KIN PHNG O TO

Sn La, ngy
thng
nm 20 .
NGI LM N

XC NHN (*)
(ca a phng hoc bnh vin)

KIN PHNG CNG TC CHNH TR

(*) Nu xin tm dng hc v hon cnh kh khn th xc nhn a phng, nu v l do sc

khe th km theo giy xc nhn ca bnh vin cp huyn tr ln.

B GIO DC V O TO
TRNG I HC TY BC

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

N XIN TR LI TIN HC TP
Knh gi: Ban Gim hiu Trng i hc Ty Bc
Ti tn : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . M s sinh vin : . . . . . . . . . . . . . . . .
Ngy thng nm sinh : . . . . . . . . . . . . . . . . . . . Ti: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.............................................................................
Nguyn l sinh vin Lp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kha: . . . . . . . . . . . . . . . . . . .
Khoa: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .H o to: . . . . . . . . . . . . . . . . . . . . . . .
H khu thng tr :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . .
Ti c vic trnh by nh sau:
T nm hc 20

- 20

, ti c tm dng tin hc tp........ hc k

v . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
theo Quyt nh s: . . . ../Q-HTB-CTCT ngy . . . thng . . . . nm 20 . .
Nay ht thi gian dng tin , ti lm n ny km theo bn kim im c xc
nhn ca a phng knh ngh Ban Gim hiu cho php ti c tr li Trng tip tc hc
tp.
Rt mong c s chp thun ca Ban Gim hiu!

KIN CA BAN CH NHIM KHOA

KIN PHNG O TO

Ngy
thng
nm 20
NGI LM N
(K v ghi r h tn)

KIN PHNG CNG TC CHNH TR

B GIO DC V O TO
TRNG I HC TY BC

CNG HO X HI CH NGHA VIT NAM

c lp T do Hnh phc
---------------------------------

N XIN NGH HC
Knh gi:

Ban Gim hiu, Phng Cng tc chnh tr

Ban Ch nhim khoa......

Tn em l: ....
Sinh ngy.........thng........nm ................................................................................
Qu qun:.....
L sinh vin lp:..............
Em vit n ny xin ngh hc vi l do:...
..
..
a ch ni ngh:...
Thi gian xin ngh t ngy ...thng.n ngy.thng nm 20
kin ca lp trng

kin GV ch nhim

Phng Cng tc chnh tr

Sn La, ngy
thng
nm 20
Ngi vit n

kin ca Ban Ch nhim khoa

Ban Gim hiu

B GIO DC V O TO
TRNG I HC TY BC

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

N XIN THI HC
Knh gi : Ban Gim hiu Trng i hc Ty Bc
Ti tn l:. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .M s sinh vin :. . . . . . . . . . . . ..
Ngy sinh :. . . . . . . . . . . . . . . . . . . . .H khu thng tr (ghi chi tit a
ch):. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..................
Hin ang hc lp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Kha : . . . . . . . . . . . . . . . . . .
Khoa: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . H o to: . . . . . . . . . . . . . . . .
Ti lm n ny knh ngh Ban Gim hiu Trng i hc Ty Bc cho php ti c thi
hc k t ngy . thng nm 20 (Hc k . . Nm hc . . . . . . . . . . . . . . . . . . . . )
L do thi hc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rt mong c s chp thun ca Ban Gim hiu!
KIN CA GIO VIN CH NHIM

KIN CA BCN KHOA

Sn La, ngy
thng
nm 20 .
NGI LM N

XC NHN CA A PHNG
HOC BNH VIN (*)

KIN PHNG O TO

KIN PHNG CNG TC CHNH TR

(*) Nu thi hc v hon cnh kh khn th xc nhn a phng, nu thi hc v l do sc

khe th km theo giy xc nhn ca bnh vin cp huyn tr ln.

B GIO DC V O TO
TRNG I HC TY BC
S:

/XN-HTB-CTCT

CNG HO X HI CH NGHA VIT NAM

c lp T do Hnh phc
Sn La, ngy

thng

nm 2011

GIY XC NHN
TRNG I HC TY BC
Xc nhn Anh (ch): .....................................................
Ngy sinh:.................................................................................................................
H khu thng tr trc khi nhp Trng (Ghi chi tit a ch): ..........................
...................................................................................................................................
Hin l sinh vin nm th Lp......
Khoa:. Kho hc: ..................................................
H o to:....
S th sinh vin (M s SV): .......................................................
Giy xc nhn ny cp cho sinh vin lm h s (hng) ..............................................
............................................................................................................................................
Lu :
- Giy xc nhn ch c gi tr
khi s dng ng mc ch;
- Giy xc nhn c gi tr
trong vng 30 ngy, k t ngy k.

T/L HIU TRNG

MU S: 01/TDSV
(Do HSSV lp)

TRNG I HC TY BC

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
GIY XC NHN

H v tn sinh vin:.............................................
Ngy sinh://..Gii tnh:

Nam

CMND s: .............................. ngy cp ....../......./......... Ni cp: ................................................

M trng theo hc (m quy c trong tuyn sinh H, C, TCCN):..........................
Tn trng: .....
Ngnh hc:..........................
H o to (i hc, cao ng, dy ngh):.........
Kho:...Loi hnh o to:...............................
Lp:.....S th HSSV:......
Khoa:...............................
Ngy nhp hc:../../.. Thi gian ra Trng (thng/nm):...//...........
(Thi gian hc ti Trng: .. thng)
S tin hc ph hng thng:............................ng.
Thuc din:

Thuc i tng:

- Khng min gim

- Gim hc ph
- Min hc ph
- M ci
- Khng m ci

- Trong thi gian theo hc ti Trng, anh (ch) .....................................................

khng b x pht hnh chnh tr ln v cc hnh vi: c bc, nghin ht, trm cp, bun lu.
- Hc sinh, sinh vin sau khi nhn tin vay, np tin hc ph cho trng:
vo ti khon:................. S ti khon:
, ti ngn hng.........
Sn La, ngy thng nm

T/L HIU TRNG

CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
------------------------------, ngy.thng.nm
20
N XIN HNG TR CP X HI
Knh gi:

- UBND X, Phng, Th trn..

- Ban Gim hiu Trng i hc Ty Bc

Tn ti l (vit ch in hoa c du) : .Nam/N

Ngy, thng, nm sinh: ...Dn tc: (ghi r thnh phn dn tc)
ang hc ti lp .. Trng i hc Ty Bc
H khu thng tr: Thn (bn, t)..X (Phng, T.trn) .
Huyn (Th x, Thnh ph) Tnh..
Cn c quyt nh s 1121/1997/Q-TTg ngy 23/12/1997 v quyt nh
194/2001/Q-TTg ngy 21/12/2001 ca th tng Chnh ph; Cn c thng t lin tch s
53/1998/TTLT/BGD & T - BTC v thng t s 13/2002/TTLT/BGD & T - BTC ca lin
B Gio dc v o to - B Ti chnh - B Lao ng - Thng binh - X hi hng dn thc
hin ch hc bng, tr cp x hi i vi hc sinh - sinh vin cc trng o to cng lp.
Ti nhn thy hin nay (gia nh) ti thuc din (nh du X vo tng ng):
- Ngi dn tc thiu s vng cao:
+ Dn tc:
+ H khu thng tr (36 thng tr ln) ti:
...
- M ci c cha ln m, khng ni nng ta:
- Ngi tn tt theo quy nh ti Ngh nh s 81/CP ngy 23/11/1995:
- H ngho:
+ C giy chng nhn s: .
+ Gi tr s dng n ngy: ..
Ti lm n ny knh mong cc c quan xt cho ti c hng ch tr cp x hi.
CHNG NHN CA UBND X, PHNG
..

NGI LM N
(K, ghi r h tn)

UBND x, phng .. .
xc nhn sinh vin .
thuc din .
Ngy..thngnm 20
T/M UBND X, PHNG, TH TRN DUYT
(Ghi r chc danh, k tn, ng du)

TRNG H TY BC XT
c Khng c TCXH
HIU TRNG

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
N NGH CP TIN H TR MIN, GIM HC PH
(Dng cho sinh vin ang hc ti cc c s gio dc ngh nghip v gio dc i hc cng
lp; mu km theo Thng t lin tch s 29 /2010/TTLT-BGDT-BTC-BLTBXH ngy 15/11/2010
ca Lin B Gio dc v o to, B Ti chnh v B Lao ng-Thng binh v X hi)

Knh gi: Phng Lao ng - Thng binh v X hi huyn..............................

H v tn sinh vin:..................................................................................................
Ngy, thng, nm sinh:...........................................................................................
Ni sinh:..................................................................................................................
H tn cha/m hc sinh, sinh vin:......................................................................
H khu thng tr (ghi y ):
X (Phng): ..................................Huyn (Qun): .....................................
Tnh (Thnh ph): .......................................................................................
Ngnh hc: ................................................M sinh vin:.....................................
Thuc i tng: (ghi r i tng c quy nh ti Thng t Lin tch hng dn
Ngh nh 49):.................................................................................................................
Cn c 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 Ty Bc xc nhn anh/ch: ...........................................................

Hin l sinh vin nm th .................. Hc k:.............. Nm hc....................................

Lp.................................... Khoa.............................. Kha hc ........t nm .......... n
nm........ thuc h o to ........................................................ ca Nh trng.
K lut: .........................................................................(ghi r mc k lut nu c).
S tin hc ph hng thng: ............................ ng.
ngh Phng Lao ng - Thng binh v X hi cp huyn xem xt gii quyt
tin h tr min, gim hc ph cho anh/ch ..................................................................
theo quy nh v ch hin hnh!
Sn La, ngy .....
thng......nm ..........
T/L HIU TRNG

MU S: 05/TDSV
(Do HSSV lp)
CNG HA X HI CH NGHA VIT NAM
c lp - T do - Hnh phc

GIY CAM KT TR N
Knh gi: Trng i hc Ty Bc
H v tn sinh vin:....................................................
Ngy sinh://.. Gii tnh: Nam
N
CMND s: .............................. ngy cp ....../......./......... Ni cp: .......................
Lp:..................................... Kho.................................... M SV ........................
Khoa ................................................................... H o to: ...............................
H o to (i hc, cao ng): ........................................................................
Ngy nhp hc: .../..../... Ngy ra trng (d kin) : ..../...../..
M trng theo hc (m quy c trong quy ch tuyn sinh): TTB
Trong thi gian theo hc ti c (gia nh) vay vn Ngn hng chi ph cho
hc tp ti trng theo Kh c (Hp ng) vay vn do ... .........................
c tr ti thn (p, lng..) ....................... x (phng)..................... huyn (th
x)...................... tnh (thnh ph) .........................., ng tn vay vn ti Ngn hng
Chnh sch x hi ................................... cho vay tng s tin
l:
........................
ng
(bng
ch............................)
Ti xin cam kt trch nhim vi Nh trng v gia nh:
- Trong thi gian 60 ngy, k t ngy c k Hp ng lao ng, ti s thng
bo a ch n v cng tc cho Nh trng v gia nh, ng thi ti c trch nhim
cng gia nh tr n s tin vay Ngn hng cho ti i hc.
- Nu khng thc hin cam kt trn, th Ngn hng, gia nh v Nh trng c
quyn lm vic vi ngi c trch nhim ti n v ti ang cng tc tr thu nhp tr
n cho ngn hng ni gia nh (hc sinh, sinh vin) vay vn.
..............., ngy ...... thng ........ nm 2011
NGI CAM KT
(K, ghi r h tn)