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["上海市残疾学生免费教育申请表"]
["学校名称: 上海健康医学院附属卫生学校                         "]
["姓名",null,null,"性别",null,"出生年月"]
["残疾类别",null,null,"领取证件名称"]
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["家庭住址",{"$nulls":4},"联系电话"]
["监护人情况","姓名",{"$nulls":3},"与学生的关系"]
[null,"工作单位",{"$nulls":3},"联系电话"]
["申请情况说明",{"$nulls":3},"区县残联证明（单位盖章）"]
[]
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["申请人签名"]
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["班主任意见",null,"学院意见",null,null,"学校意见"]
[]
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