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["北航现代远程教育毕业证明申请表"]
["学习中心名称",null,"学号"]
["申请人姓名",null,"身份证件号码"]
["层次",null,"专业"]
["申请原因"]
[]
[]
[]
[]
[]
[]
["申请人签字",null,"申请日期"]
["校外学习中心\n审核人签字",null,"学习中心意见\n\n(公章)"]
[]
[]
[]
["学      院\n审核人签字",null,"学院审批意见\n\n（公章）"]