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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"]
[]
["备注："]
["可选择支教地点：",null,null,"可选择支教时间"]
["安徽淮南潘集区平安希望小学 ",null,null,"第一期：2007年5月-6月"]
["贵州织金县平安希望小学  ",null,null,"第二期：2007年9月-10月"]
["甘肃牛河平安希望小学   ",null,null,"每位志愿者支教时间为10天，具体支教时间根据小学实际情况进行安排。"]
["山西左权平安希望小学"]

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