上海市义务教育学生资助申请汇总表
学校名称（公章）： 　 　 2015学年 第一学期
序号 班级 姓名 资助金额（元）项目 餐费 课外教育活动费 校服费 校车费 城镇居民基本医疗保险费   合计
收费标准                                             7.5/8             100         85/150                100
1 一3        查                                       742.50          100         320                     100                               1262.50
2 二3        李                                       742.50          100                                    100                                942.50
3 三2        金                                       742.50          100                                    100                                942.50
4 四1        张                                       742.50          100                                    100                                942.50
5 四1        马                                       742.50          100                                    100                                942.50
6 四2        王                                       742.50          100                                    100                                942.50
7 四2        王                                       742.50          100                                    100                                942.50
8 四4        叶                                       742.50          100                                    100                                942.50
9 四4        水                                       742.50          100                                    100                                942.50
10 五2      李                                       742.50          100                                    100                                942.50
11 五4      恽                                       742.50          100                                    100                                942.50
12 五4      潘                                       742.50          100                                    100                                942.50
13 五4      仇                                       742.50          100                                    100                                942.50
14 六1      郑                                       792               100                                    100                                992
15 六3      张                                       792               100                                    100                                992
16 七2      徐                                       792               100                                    100                                992
17 七3      傅                                       792               100                                    100                                992
18 九2      黄                                       792               100                                    100                                992
19 九2      常                                       792               100                                    100                                992
20 五3      冯                                       742.50          100                                    100                                942.50
21 九2      安                                       792               100                                    100                                992
22 六2      陈                                       792               100                                    100                                992
　　合计 ——                                  16731             2200      320                      2200                              21451

单位负责人： 刘爱武 填表人： 沈剑锋 填表日期： 2015 年 10 月 30 日
注：1.此表需一式两份；2.学校应将《资助申请表》、相关证明材料以及资助申请汇总表上报学生资助管理部门；3.学生资助管理部门应对学校上报的《资助申请表》、相关证明材料和资助申请汇总表进行复审，复审后应将《资助申请表》、相关证明材料以及资助申请汇总表（一份）退回学校留存。

上海市洛川学校