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["“新农村 新希望”中国平安希望小学支教行动报名表"]
["姓名",null,null,"性别"]
["年龄",null,null,"手机"]
["身份证号码"]
["学历程度",null,null,"毕业院校"]
["家庭住址"]
["工作单位",null,null,null,"担任职务"]
["适宜支教时间（请参考备注说明时间）",null,null,"是否愿意接受时间调整"]
["想去的学校",null,null,null,"是否愿意接受地点调整"]
["E-MAIL地址"]
["个人经历"]
[]
[]
["自我评价"]
[]
[]
[]
[]
["特长课程（希望教学课程）"]
[]
[]
[]
[]
["是否准备教案，准备请附后"]
["是否同意调整"]
["报名表格填写时间"]
["报名方式：","①填写完毕请发送到xiwangjiaoshi@pingan.com.cn；"]
[null,"②拨打当地报名联系人电话进行报名。"]
[]
["选择支教地点及时间请参考后表格填写。"]
["支教地点选择"]
["支教省份","具体支教学校","当地报名联系人","报名联系电话"]
["陕西","延安市志丹县双河平安希望小学","袁磊","0911-2938222"]
["广东","广东省阳西团结平安希望小学","张振华","020－38261513"]
["浙江","浙江省龙泉市龙南乡平安希望小学","陈静","0571－87556868"]
["河北","河北省赞皇县南邢郭乡东郭家庄平安希望小学","吴玉莲","0311-85923056"]
["宁夏","宁夏泾源县大湾乡平安希望小学","赵静","0951－6712272"]
["贵州","贵州省织金官寨小妥倮平安希望小学","胡婧","0851-5500743"]
["内蒙古","内蒙古岱海平安希望小学","李恩艳","0471-3328022         "]
["云南","云南省文山州丘北县天星乡笼陶村平安希望小学  ","刘明辉","0451-55539012"]
["广西","广西天等县上映乡平安希望小学","罗浩文","0771-5525923"]
["甘肃","甘肃会宁县牛河平安希望小学","李会荣","0931-8487771"]
["河南","河南省濮阳县徐镇平安希望小学","张凯","0371-60108021"]
["安徽","安徽省六安市顺河平安希望小学","郑丹","0574-87680954"]
[]
["支教时间：","2008年9-11月间（每期支教时间为10天）"]

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