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["蚌埠学院信息公开申请表"]
["申\n请\n人\n信\n息","公民","姓　　名"]
[null,null,"联系电话",null,"传　　真"]
[null,null,"电子邮箱",null,"邮政编码"]
[null,null,"联系地址"]
[null,"法人或其他组织","名　　称"]
[null,null,"联系人姓名"]
[null,null,"联系人电话",null,"传　　真"]
[null,null,"联系地址"]
[null,null,"电子邮箱"]
[null,"申请时间",null,"年　　月　　日"]
["所\n需\n信\n息\n情\n况","所需信息的内容描述"]
[]
[]
[]
[null,"所需信息的用途"]
[]
[null,"获取信息的方式（可选）"]
[null,"□邮寄　　 □电子邮件　　 □传真　　 □自行领取"]
["承诺","申请人提供的信息真实有效。　　　\n\n 申请人签名或盖章："]