CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
N NGH CP TIN H TR MIN, GIM HC PH
(Ph lc III - Dng cho hc sinh, sinh vin ang hc ti cc c s gio dc ngh nghip
v gio dc i hc cng lp)

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 hc sinh, sinh vin: ...
H khu thng tr (ghi y ):
X (Phng): .......................................Huyn (Qun): ...............................
Tnh (Thnh ph): ........................................................................................
Ngnh hc: .... M s sinh vin:
Thuc i tng:(ghi r i tng theo Thng t lin tch hng dn Ngh nh 49 )
..
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 tn v ghi r h tn)

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

Trng i hc Bch Khoa H Ni
Xc nhn anh/ch: .................................................................................................................
Hin l sinh vin nm th ...... Hc k:.... Nm hc........................ lp ...........................
Khoa/vin ........... kha hc......................thi gian kha hc .......(nm)
H o to ........................................................ ca nh trng.
K lut: ................................................................................ (ghi r mc k lut nu c).
S tin hc ph trong hc k l: ........................................ng/hc k

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.
H Ni, ngy ..... thng ..... nm ...........
Th trng n v
(K tn, ng du)