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["上海师范大学研究生高端教育实践实习申请表"]
["姓名",null,"学号",null,"申请实习学科"]
["性别",null,"导师",null,"是否有中学教师资格证"," 有□   无□"]
["硕士专业",null,"所在学院",null,"年级","2011□  2012□ "]
["本科毕业院校",null,"本科毕业专业",null,"本科是否师范生"," 是□   否□"]
["联系电话",null,"Email"]
["学生类别","教育硕士□　　课程与教学论□      3+3□         其他□"]
[]
["个人经历:"]
["1）教育经历："]
[]
[]
[]
["2）教学经历："]
[]
[]
[]
[]
["本人承诺：11-12月全程能够参加实习。"]
[]
["                                               本人签名："]
["                                               "]
[]
["导师推荐意见："]
["该生具备实习基本技能，并能够全程参加实习。"]
[]
["                                               导师签名："]
["                                          "]
[]
["学院意见："]
[]
["　　　　　　　　　　　　　　　　　　　　　　学院负责人签名："]
["                                学院盖章"]
[]
["注："]
["1、请将此表打印在一张A4纸上，若内容过多，请正反面打印。"]
["2、此表填写好之后请于10月8日前交于各学院教务员老师处。"]

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