CQNG HOA XA HQI CHU NGHIA VIE,T NAM

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Mau 2b-D'IHTNNT

CQNG HOA XA HQI CHU NGHIA VIE,T NAM

DQc

lflp

-

Tq

do -

H4nh phfc

DoN XIN DAY rUttU NGOAI NHA TRU0NG

Kinh gfri: Ban Girlm

hiQu

Trudng THPT

^chuy6n

L0 Quf

^Ddn

TOi tdn ld:

Dcrn

vf

c6ng t6c:

T6: ...,... - Truilng THPT chuy6n LO Quf Edn s6 c\zn'tp: ..so

aiqn tho4i.

Dia chi thudng

trti:

Trinh d0 ddo

tpo:...

. Chuy6n ngdnh ddro

t4o:....

HiQn dang dugc phdn c6ng gi6ng day m6r/lcrp:

'...

Tdng s0 ti6t dugc phAn c6ng o trudng

fte

^ca^ki0m^nhiOm):.'.'...'...

Nay

xin

ducrc d4y th6m tai co s0:

Dfa chi:

M6n d4y th6m:

Llch

d3y cB the

nhu

sau :

Chuong

trinh

c6p

hoc:...

Mirc thu hgc phi: theo thoa thu4n giira Trung tdm dpy th6m

v6i

php huynh hgc sinh.

*

Hi

so

kim

theo:

- K€ hoqch/Chaong trinh gidng

dqy

cita

cdc

tdp ddng

^{hj, (bdn}

cirng n\p

trurc fiAp

khi

npp don. Bdn mdm nQp

vi dia chi email:

thpt-lequydonqt@,qugngtri.edu.u-tl);

- Ban sao _Quyi5t

dinh

cdp

phip

dqy thAm

cila

co sd ddng

hi'giang

^dcty,

TOi

xin

cam

doan:

Co ph6m ch6t dao duc

t6t,

thqc hiQn dAy du nghTa

vu

cdng ddn vd c6c quy dinh cua ph6p luQt; hodn thdnh c6c nhi6m

vp

dugc giao

t4i co

^quanc6ng t6c; khdng thuOc c6c dOi tuqng kh6ng dugc phdp tham gia d4y th6m theo c6c quy dinh.

TOi

xin

cam doan thqc hiQn dAy du, nghiCm tirc c6c Quy dinh ^vCday th6m hgc th6m tai Th6ng

tu

s6 L7I2}|21TT-BGDDT ngdy

161512012

cua BQ Gi6o duc vd Ddo t?o, Quy6t diSh

^so

02l20l3lQD-UBND

ngiry

2llO1l20l3

cua

UBND

tinh

Quing Tri

vd c6c cdng vdn hucrng ddn d4y thOm, hgc th0m cira So Gi6o dpc vd Ddo tpo tinh

Quing Tri

vd cua Nhir trucrng./'

V

t<iii" cria

Chri

co ^sO

noi il5ng kf D6ng Hd, ngdy.'....tl1ang 9 ndm 2019 d4y th6m Nguoi vi6t

dcrn

(Ky

t0n, ghi hq vd t6n, d6ng

dAu) (Ky tOn, ghi hq vd t6n)

STT ^Lcrp

Ndi

dung giang ^d41'

Thcri gian

(gio/thu)

Ghi chit

Budi

I

Bu6i

²

nu6i :

(ncu L'o )