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["                                         填表时间:         年     月     日"]
["姓  名",null,"所属系         及班级",{"$nulls":3},"出生年月"]
["家庭住址",{"$nulls":4},"联系电话","手机"]
[{"$nulls":6},"住宅"]
["申请走读   理由",{"$nulls":4},"学生签名:"]
["家长意见",{"$nulls":4},"家长签名："]
["  辅导员（班主任）意见　"]
["系意见"]
["备  注"]
[]
["    注:","1.走读期间学生的管理、教育由家长负责。"]
[null,"2.走读期间所发生的一切事情、后果由家长负责。"]
[null,"3.本表一式二份，系、家长各一份。"]