Annex 1 Questionnaire on college students and their families School: College (Department): Major: grade: Basic information of students ID card No. Graduatio n School Family Type Nation Before entering Political school Urban Rural outlook Registere d residence Family Populatio n size □ orphan □ single parent □ disabled □ child of martyr or special care object □ family with minimum guarantee □ poverty-stricken family with file and card Other Home mailing address Post Office Code Full name Date of birth Gend er Full name Contact number Main family members Ag e And students relationship Occupati on Work (Study) unit Annu al inco me (yuan ) Healt h Family information Annual family income (yuan).Students have been subsidized in this academic year 。 The family suffered an unexpected event:. Unemployment of family members:.Family debt situation and reasons:. Other information:. I promise that the above information is true and correct, and I will accept it. If it is not true, I am willing to bear the corresponding consequences. Signature of the student: signature of the parent or guardian of the student: Date: Student family Signature and seal Signature of handler: Company Name: of local (with official seal) township Contact number: or street Specific date Civil Affairs Departme nt Note: this form is for students to apply for family financial difficulties and national student loans.Photocopying.Please fill in the form truthfully and submit it to the school after verification and seal by the Civil Affairs Department of the township (town) or street where your family is located.If the township (town) or street civil affairs department does not have a special official seal, it can be sealed by the government.

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