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["  批次：                      组别：                     序号："]
["金钢锻造助学医科百人计划申请表"]
["学生本人情况","姓名",null,"性别",null,"民族",null,"出生\n日期",null,"六个月内彩色\n免冠一寸照片\n(电子版)"]
[null,"身份证\n号码",{"$nulls":3},"政治\n面貌",null,"毕业\n高中"]
[null,"高三班级",null,"高三班主任\n姓名",{"$nulls":3},"高三班主任电话"]
[null,"录取高校",null,null,"专业",null,null,"高考\n成绩","      分 文/理\n第    次高考"]
[null,"特困","     是\n     否","孤残","   是   孤   残\n   否     ",null,"单亲","     是\n     否","烈士或优抚\n对象子女","        是\n        否"]
[null,"户口所在地址"," 区/县       镇        村      组/号",{"$nulls":4},"现住址"]
["批后填写","银行卡号",{"$nulls":3},"开户（分）行",null,null,"银行预留\n电话号"]
[null,"银行卡号",{"$nulls":3},"开户（分）行",null,null,"银行预留\n电话号"]
["家庭成员情况","姓名","与本人\n关系","联系电话",null,"工作（学习）\n单位",null,"年龄","年收入\n（万元）","村（街道）委会证实家庭情况"]
[null,null,"父",{"$nulls":6},"村（街道）委会\n（章、主任签字、电话号码）\n\n\n    \n    年   月   日"]
[null,null,"母"]
[]
[null,"邮寄地址",{"$nulls":6},"邮编"]
["在校期间奖励情况"]
["签字盖章","本人签字","我立志学医为民为国，为完成大学学业，请求资助。                                \n                                            年  月  日",{"$nulls":5},"学校（章）\n（获准后盖学校章）\n\n\n\n年   月   日"]
[null,"父母或监护人签字","上述信息真实，同意申请。                \n                                            年  月  日"]
[null,"高三班主任意见","上述信息真实，同意申请。                \n                                            年  月  日"]
["审核结果",{"$nulls":7},"金钢锻造（章、签）\n\n\n\n年   月   日"]
[]
["注：","需同时提交 1.身份证\n          2.户口本",{"$nulls":3},"3.高中毕业证\n4.大学录取通知书",null,null,"5.高考成绩单\n6.奖状、困难证明。"]

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