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["长沙理工大学继续教育学院\n函授站推荐教师登记表"]
["站名：         ",null," ",null,"编号："," "]
["姓名"," ","性别"," ","出生年月"," "]
["职称"," ","学历",null,"是否退休"]
["毕业学校及专业"]
["现在何单位从事何工作"]
["通信地址"]
["有效电话号码\n（须写明区号）",{"$nulls":3},"邮编"]
["是否愿意承担函授教学任务",null,null,"是否可以到外地授课\n（此栏只须长沙地区的教师填写）"]
["曾经主讲过的课程"]
["有能力承担的课程"]
["函授教师的具体要求"]
["备   注"]
["填表说明：1、本表一式二份，须由函授教师亲自填写，一份送交函授部，一份留函授站\n                         备查。函授站将此表与《函授站推荐教师审核汇总表》一并送交函授部。  \n                    2、“编号”一栏由函授部统一填写。"]

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