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证件照可彩色

或者黑白打印

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基本信息请务必认

真填写并仔细核对

准确,该表纸质版

提交盖章后将存入

学生个人档案

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具体地址

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拟取得

的学历

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正反面总共两页纸,双面A4打印,不得超页

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纸质版手写签字

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填写意见

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填写意见

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签名可用签章

盖公章

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日期晚于学生

填表日期

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填写日期

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毕业时的

政治面貌

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