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["湖南大学已毕业学生延期在校住宿申请表"]
["姓  名",null,"性  别",null,"学  院",null,"学  号"]
["联系电话",{"$nulls":3},"身份证号码"]
["申请延期离校原因",{"$nulls":5},"离校时间"]
["本人承诺："]
["1.遵守学校校纪校规，不在学校内从事违法乱纪行为。"]
["2.提高自我防范意识，做好防火防盗措施，保证在学校内不发生安全责任事故。"]
["3.服从学校管理和住宿安排，爱护公共卫生，爱护公共财物，维护学校正常秩序。"]
["4.自愿交纳设备设施押金100元，如损坏公共财物照价赔偿。"]
["承诺人签名：                                 日期：                 "]
["学院意见："]
[]
[]
[{"$nulls":5},"    学院盖章 "]
[{"$nulls":5},"     日期："]
["园区中心意见："]
[]
[]
[]
[{"$nulls":5},"  园区中心盖章 "]
[{"$nulls":5},"      日期："]
["注：1、设备设施押金在毕业生离校交还钥匙、设备设施验收合格后退还，如有损坏按物价部分核定的维修价格表收取维修材料费。2、此表由学院在6月27日前统一交至园区中心邓昌富老师处备案。"]

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