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 my tnh, cng thng thn kinh, tm l theo
mc VIII ca quyt nh s 1453/LTBXH-Q ngy 13/10/1995 ca b trng b LTBXH.
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 Khoa hc T nhin 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 theo hc k:.....................................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.
XC NHN CA KHOA
Xc nhn SV c thng xuyn tip xc
vi mn hnh my tnh thng qua thc
hnh ti phong my v lm n mn
hc.

Ngy ...... thng ..... nm ...........

TL.HIU TRNG