ChlJ.O.ngTrinh HQc Bong USP 2017DO'N XIN cAp HQC BONGTruong f)~i H9C: C.1n ThO'

ietHope------Phin I: Thong tin v~ sinh vi€m

HQva ten: Giai tfnh: Nam D

Ngay thanq narn sinh: / / .

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se dien thoai 2 : cua ..(ghi ro so (Ji~ntboei /tJ cue sinh vien hay ngU'&ithan hay ben be hay nhtJiro)

Email (sinh vien PHAI t~o 1email ntw cture co): ..

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: Nqanh hoc: Lap hoc: Ma s6 SV: ..,,IL ,

Hay Ii$t ke ket qua hoc tap, thi f)H va cac giai thU'ang/hoc bong (neu co) tll' narn hoc lOop10

(Chi li~t ke cac giai thU'imgh9Ct~p ceo quae tel quae gia Ikhu vue/ ilnh/ tnent: pha Tlt\t?

LOop f)iem tong keti Giai thU'ang (neu co, nho g&i l.oai hoc bong (ntJUco) Tri gia hoc bongf)iem thi f)H kern ban sao gitw khen)

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Em co dang di lam them kh6ng ? Co D Kh6ngD, . I' . .. , ?Neu co, em am cong VI~C gl .

Thu nh$p bao nhieu ? I thang

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ChU'O'ng Trinh HQc Bong USP 2017DO'N XIN cAp HQC BONGTruong f)~i Hoc: C~n Tho

VietHope------

Phan II: Thong tin v{Jgia dinh Ho va ten sinh vien: .

Ten eha: Narn sinh: .Hoc VEin: Kh6ng di hoe0 Tieu hoeD THCS0 THPH0 D(3ihoeD Kh6ng biet D

Nghe nqhiep: .I------------------------------------------~: Thu nhap binh quan thea thanq: .Ithang :~------------------------------------ I

Sue khoe: Binh thU'cmgO

Bi benh hiern nqheoDDa matO

Mat sue lao dongDKh6ng eo eha/eha be di tCl'lauD

Bi benh man tinhO

Neu b] benh, ghi ro benh gilly do mat sue lao dong? .

Ten m~: Nam sinh: .Hoc van: KhOngdi hoeD Tieu hoeD THCSD THPH0 D(3ihoeD Kh6ng bietD

Sue khoe: Binh thU'angD

Bi benh hiern nqheoD

I------------------------------------------~Nghe nghi$p: : Thu nhap blnh quan thea thanq: .Ithang :

~------------------------------------ I

Da maO Kh6ng eo me/me be di tCl'lau D

Mat sue lao dong D Bi benh man tinhD

Neu bi benh, ghi r5 benh gi/ly do mat sue lao dong? .

NO'ia cua eha me hien nay: .Tinh tranq hen nhan cua eha me: Sinh thU'cYngD Ly di D Ly than D

Neu cha me Iy di thi ngu'&i con 19ic6 dong g6p I tro cap nuoi can khong? C6D Khong D~------------------------------------------------------------------------,I., I

:Co nQpGiay Ch(J'ngNh~n He)Ngheol Giay X3C nh~n gia cimh kho khan hay khong?I. 1

: C6 Gi~y Chung Nhciln HQ ngheo D C6 Gi~y xac nhciln gia canh kh6 khan D KhOng c6 D :L 1

Li~tke nhCPngth~mhviim c611loajtrong gia dinh:eng ba (song eung ba m~), anh chi em rUQtQuan h$ Thu nh$p/ L$p gia

HoTen Tuoi v&i sinh Nghe nghi$p dinh Cho a hi$n nayvien thang chU'a??

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ChU.O.ng Trinh HQc 86ng USP 2017DO'N XIN cAp HQC BONGTruong D~i HQc: c~oTho

VietHope...' ........_--Ph~nIII: Trinh bay Ho va ten sinh vien: ..

1. Em hay trinh bay mot each chi ti~t nh§t ve hoan canh gia dinh em hien nay va nhCrngkh6khan, thLrthach da g$p phai khi theo duoi viec hoc. N~u nhan du'o'cHoc bong USP, ban se SLrdl,mgso tien Hoc Bong nhu th~ nao? (kh6ng viEd nhifw han phan de trang trang khung)

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ChlJ'O'ng Trinh HQc Bong USP 2017DON XIN cAp HQC BONGTruong D(_:liHQc: C~n Tho

VietHope------

Phcin III: Trinh bay (tiep thea) Ho va ten sinh vien:

2. Ban tran tro di~u gi nhat v~ tinh hinh phat trien 6> dia phuonq minh? N~u c6 the thuc hienmot dl,J'an phat trien nho 6> dia phiro'nq minh hcac noi ban dang hoc (nhan ll,J'c<10 sinh vien,thai gian 1 thanq), ban se thuc hien dl,J'an gi? Tai sao?

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