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["附件5:"]
["北京理工大学2015年接收推荐免试攻读硕士学位研究生申请表"]
[]
[" 申","姓   名",null,"性别",null,"身份证号"]
[" 请  情","毕业学校",{"$nulls":3},"毕业专业",{"$nulls":3},"照"]
[" 人","通讯地址",{"$nulls":3},"邮政编码",{"$nulls":3},"片"]
[" 基  况","联系电话",{"$nulls":3},"E-mail地址"]
[" 本","外语语种",null,"    外语等级水平及成绩",{"$nulls":3},"证书编号"]
[null,"申请学院",{"$nulls":3},"申请专业"]
["获"]
["奖"]
["情"]
["况"]
["学 科"]
["术 研"]
["成 情"]
["果 况"]
["申 承","          我保证所提交的全部材料均真实、准确。如提交信息不真实、不准确，我同意贵校拒绝"]
[" 请","我的免试申请或取消免试资格。"]
["人 诺",null,"申请人签名：",{"$nulls":3},"         年   月    日"]