情况自述
年月日 姓名： _________性别：_____年龄：_____联系电话:_______________ 系：_______班：____住宿情况：____家长联系电话：______________ 家庭地址：_________________________________________________ 陈述内容：__________________________________________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________ 第页陈述人签名：
