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["_______________________学习中心"]
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["实验/实习教师基本情况统计表  "]
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["序号","姓    名","出生年度","性别","民族","职称","学位","来源","毕业院校","所学专业","所授实验课程名称","是否参加过远程教育相关知识培训","备注"]
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[" 注：   1、“职称”分为：A、教授（包括正教授、教授级高级工程师和正研究员）；B、副教授（包括副教授、副教授级高级工程师和副研究员）；C讲师（包括讲师、中级职称）；D其他（包括助教、初级职称）等、                       "]
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["          2、“学位”分为：A、博士；B、硕士；C、学士；D、无任何学位；E、其他（请注明具体内容）"]
["                    3、“来源”分为：A、远程教育专职教师；B、校内兼职教师、C、校外兼职教师；D、其他（请注明具体内容 ）"]
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[{"$nulls":11},"学习中心（盖章）"]

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["填表示范"]
["四川省绵阳市行政学校学习中心"]
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["实验/实习教师基本情况统计表  "]
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["序号","姓    名","出生年度","性别","民族","职称","学位","来源","毕业院校","所学专业","所授实验课程名称","是否参加过远程教育相关知识培训","备注"]
[1,"王鹏","1973年","男","汉 ","高级工程师","硕士","校外兼职教师","四川大学","机械制造","金工实习","否"]
[2,"张柳","1976年","女","汉 ","副教授","硕士","校内兼职教师","北京科技大学","计算机","计算机操作实习","是"]