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["“新力苏青助学基金”申请表  (大学阶段)"]
["学校名称:",{"$nulls":6},"填表日期:"]
["个人基本情况"]
["姓名",null,"性别",null,"身份证号",null,null,"学号"]
["政治面貌",null,"民族",null,"生源地",null,null,"籍贯"]
["所在学院",null,null,"专业名称",null,null,"在校担任职务"]
["入学时间",null,null,"学制",null,null,"户口性质","农业户口( )、非农业户口（ ）"]
["家庭基本情况"]
["家庭地址",{"$nulls":5},"家庭电话"]
["联系地址",{"$nulls":5},"联系电话"]
["姓名","关系","年龄","工作单位/就读学校",{"$nulls":3},"职务","月收入","其他收入"]
[]
[]
[]
[]
[]
["家庭总人数（人）",{"$nulls":4},"人均月收入（元）"]
["每学年费用支出明细（元）"]
["每学年学费",null,null,"住宿费",{"$nulls":3},"书本费"]
["伙食费",null,null,"交通费",{"$nulls":3},"其他杂费"]
["预计每学年费用收支差额"]
["家       庭       经       济       情       况       简       述"]
{"$rows_empty":7}
["请如实填写现在在校内外所受各项奖、助、补、免项目"]
["序号","资助项目名称",{"$nulls":3},"资助金额","资助开始时间","资助截止时间","资助周期","备注"]
[1]
[2]
[3]
[4]
[]
["本人承诺："]
["一、向“新力苏青助学基金”所提供的一切资料均真实无误，并无弄虚作假；"]
["二、将秉承“新力苏青助学基金”所倡导的宗旨，努力学习，积极进取，自强自立；建立"]
["    为国为民，回报社会的精神，做一个有益于国家，有益于社会，有益于人民的人。"]
[]
[{"$nulls":6},"申请人签名："]
[{"$nulls":6},"日  期："]
[]
["辅导员意见：",{"$nulls":4},"学院意见："]
[]
[]
[]
[]
[null,null,"辅导员签名：",{"$nulls":4},"负责人签名："]
[null,null,"日   期：",{"$nulls":4},"日   期："]
["备注：1、如学生本人现有参加兼职工作，请在“家庭基本情况”的“其他收入”栏内列明；"]
["      2、如学生本人现在是在享受社会最低生活保障的，请同时提供有效期内“低保证”的复印件。"]
["      3、如内容太多，以上表格位置不够的，可另附页填写，和此表一起提交。"]

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