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["附件2"]
["高等学校学生及家庭情况调查表"]
["学校：",null,"         院系：",{"$nulls":3},"专业：","班级："]
["学生本人","姓名",null,"性别","□ 男 □ 女","出生日期",null,"    年  月  日","民族"]
[null,"身份证号码",{"$nulls":3},"政治面貌",null,null,"入学前户口","□城镇 □农村"]
["基本情况","毕业学校",{"$nulls":3},"健康状况",null,null,"婚姻状况"]
[null,"孤残","□ 是  □ 否",null,null,"单亲",null,"□ 是 □ 否","烈士子女","□ 是 □ 否"]
["家庭基本情况","家庭地址",{"$nulls":3},"邮政编码",null,null,"家庭电话"]
[null,"家庭成员关系","姓名","工作单位",{"$nulls":3},"身份证号码","单位电话","健康状况"]
[null,"父亲"]
[null,"母亲"]
[]
[]
[]
[]
["影响家庭经济状况有关信息","1、家庭年收入      元，家庭每月可提供的生活费      元/月；"]
[null,"2、学生本年已获资助情况（含社会直接资助款）："]
[]
[null,"3、家庭遭受自然灾害情况：                ；家庭遭受突发意外事件："]
[null,"家庭成员因残疾、年迈而劳动能力弱情况："]
[null,"家庭成员失业情况："]
[null,"4、其他情况："]
[]
["签章","学生本人签字：",{"$nulls":4}," 学生家长或其他法定监护人："]
[{"$nulls":6},"（此栏不用填写）"]
[null,null,"年    月    日",{"$nulls":5},"年    月    日"]
[]
["乡镇或街道民政部门意见","通讯地址",{"$nulls":4},"邮编",null,"电话"]
[null,"    经核实学生及其直系亲属的居民身份证、户口薄和实地走访调查，该生基本信息和家庭经济困难情况属实，同意其申请国家助学贷款"]
[]
[null,"单位名称（盖章）：",{"$nulls":6},"年    月    日"]
[]
["备注："]