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["附件2"]
["广东省家庭经济困难学生认定申请表"]
["学校                               年级                      班别               学（籍）号                  "]
["学生基本情况","姓名",{"$nulls":6},"性别",{"$nulls":4},"民族",{"$nulls":4},"出生年月"]
[null,"身份证号",{"$nulls":11},"户口性质",{"$nulls":4},"□城镇   □农村"]
[null,"院系",{"$nulls":11},"专业"]
[null,"（只需高校学生填写）",{"$nulls":11},"（只需高校学生填写）"]
[null,"家庭情况","家庭人口数",{"$nulls":10},"家庭成员在学人数"]
[null,null,"赡养人数",{"$nulls":10},"家庭成员失业人数"]
[null,null,"□脱贫家庭学生   □脱贫不稳定家庭学生   □边缘易致贫家庭学生   □突发严重困难户学生"]
[null,null,"□特困供养人员   □特困职工子女         □原广东省户籍建档立卡家庭学生"]
[null,null,"□最低生活保障家庭学生        □低保边缘         □支出型困难家庭学生"]
[null,null,"□享受国家定期抚恤补助的优抚对象（含烈士子女、牺牲军人子女）、因公牺牲警察子女"]
[null,null,"□孤儿（含事实无人抚养等儿童）     □父母一方抚养       □父母一方为残疾人 "]
[null,"健康状况","□本人残疾                       □本人或家庭成员患重大疾病"]
["家庭信息","户籍地址","    省（自治区）    市     县（市、区）    镇（街道）    村（居委）         （门牌号）"]
[null,"邮政编码",{"$nulls":3},"联系电话",{"$nulls":8},"家庭人均年收入",null,null,"（人民币元）"]
["家庭成员情况（直系亲属，含祖父母）","姓名","年龄","与学生",null,null,"工作（学习）单位",{"$nulls":4},"联系电话",{"$nulls":4},"从业",null,"文化程度","年收入（元）",null,"健康状况"]
[{"$nulls":3},"关系",{"$nulls":12},"情况"]
{"$rows_empty":9}
["影响家庭经济","家庭主要收入来源类型（只能勾选填其中一项）"]
[null,"□1.工资、奖金、津贴、补贴和其他劳动收入；"]
[null,"□2.离退休金、基本养老金、基本生活费、失业保险金；"]
[null,"□3.继承、接受赠予、出租或出售家庭财产获得的收入；"]
[null,"□4.存款及利息，有价证券及红利、股票、博彩等收入；"]
[null,"□5.经商、办厂以及从事种植业、养殖业、加工业扣除必要成本后的收入；"]
[null,"□6.赡养费、抚(扶)养费；           "]
[null,"□7.自谋职业收入；           "]
[null,"□8.其他应当计入家庭的收入。"]
[null,"如无以下情形，请填写“无”，如有以下情形，请勾选□"]
[null,"1.突发事件："]
[null,"□家庭遭受疫情；□家庭遭受自然灾害 ；□家庭遭受突发意外事件 ；□家庭欠债。"]
[null,"具体时间：                                                                               。"]
[null,"描述情况内容、金额：                                                                     。"]
[null,"2.其他情况：                                                                             。"]
["佐证材料","学生或监护人填写所提交的证件名称和相关佐证材料："]
[]
[]
["签 章","学生本人已满16周岁，只需本人签名；学生本人未满16周岁，需由学生家长或监护人签名。"]
[null,"本人承诺以上所填资料真实、准确，并同意授权相关部门通过信息核对，对所填资料进行查询、核对。",{"$nulls":10},"本人是         学生的（□父亲□母亲□监护人），以上所填资料真实、准确，同意授权相关部门通过信息核对，对所填资料进行查询、核对。"]
[null,"如虚报资料，本人愿意承担相关责任。",{"$nulls":10},"如虚报资料，本人愿意承担相关责任。"]
[]
[]
[]
[null,"手写签名：",{"$nulls":10},"学生家长或监护人手写签名："]
[]
[null,"                          年   月   日",{"$nulls":10},"年   月   日"]
["注：1.本表供学生根据需要申请家庭经济困难认定用，可复印。请如实填写，此表连同相关佐证材料交到学校。2.家庭成员健康状况主要填写是否患重大疾病，是否残疾及等级。3.选择性项目必须填写。4.涂改无效。"]