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["创新学分课 程 认 定 申 请 表"]
["申请学生姓名",{"$nulls":3},"学号",null,"班级",null,"学生所在学院(系、部)"]
["序号","学生已获创新实践项目信息",{"$nulls":3},"专业教育限选课、自由选修模块课程认定\n（由学生所在单位认定）"]
[{"$nulls":5},"可归属该学生所在专业中\n专业教育限选课、自由选修课程的模块"]
[null,"创新实践作品名称（或项目名称）","创新实践课程编号","学分",null,"课程模块名称"]
[1]
[2]
[3]
["学生签字：",{"$nulls":4},"学生所在专业专业负责人签字\n教学院盖章："]
["教务处审核意见：",{"$nulls":5},"经办人处理结果："]
[null,null,"教务处主管处长签名："]
[null,null,"教务处盖章"]
[null,null,"日期：    年    月    日"]
["注：1、此表一式三份（教务处、学生所在院（系部）、学生本人）。"]