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["福建省生源地信用助学贷款高校确认表                      "]
["学生基本信息","姓名",null,"性别",null,"民族",null,"政治面貌",null,"学号"]
[null,"出身年月",null,"身份证号码",{"$nulls":4},"联系电话"]
[null,"户籍地址",{"$nulls":5},"联系电话"]
[null,"详细住址",{"$nulls":5},"联系电话"]
["高校基本信息","高校名称",{"$nulls":4},"学制",null,"学费及住宿费标准"]
[null,"院系及     专业"," ",null,"所属省份",null,"高校地址"]
[null,"高校     类别1","□本科院校   □高职高专",null,null," 高校       类别2","□中央部属 □省外地方所属 □本省省属 □本省市属"]
[null,"开户行","建设银行三明市三元支行",null,"开户名","三明学院",null,null,"账号"]
["学业品行资助情况","奖惩情况"]
[null,"学习成绩及品行表现综合评定：  □优    □良    □中    □差"]
[null,"□继续就读  □考研  □专升本   □第二学位                         ",{"$nulls":4},"□结业    □肄业   □退学   □取消学籍"]
[null,"资助情况"," 是否获得高校国家助学贷款  □是    □否"]
[null,null," 是否获得生源地信用助学贷款  □是    □否"]
[null,null,"是否获得其他资助：□奖学金  □助学金  □勤工助学  □其他"]
["委托书","    本人因                                    原因，不能回乡办理第   次生源地信用助学"]
[null,"贷款发放手续，委托共同借款人               代为办理。"]
[]
[{"$nulls":7},"委托人签章：        "]
[{"$nulls":7},"    日期：      年      月     日"]
["高校意见"]
[null,null,"            系（院）盖章：",{"$nulls":4},"  校学生资助中心或学生处盖章："]
[null,null,"               年   月   日",{"$nulls":5},"    年   月   日"]
[]
["备注：1.本表是审批发放贷款的重要依据，应如实及时填报。2.学生若能自行回乡办理，不需填写委托书；若不能回乡办理，需共同借贷人持此表代为办理放贷手续。3.新生无需填写学业品行资助情况及学号。"]
[]
[{"$nulls":7}," 填表日期：     年   月   日 "]

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