証 明 書 発 行 申 請 書
                                                                                             （申請者は太枠内を記入すること。）
                                                                                                                                                                全
  東京都立                                                    学校長¹ 殿           申請年月日                                年         月          日
                                                                                                                                                                定
  下記により証明書の発行を申請します。                                            申請者氏名
 
 使用目的                                                                                                                                                  性別
                                                                                       （ ふりがな ）
                                                                                 証
                                                                                           氏           名
                                                                                 明
                                                                                           生 年 月 日                           年           月           日生
 
                                                                                 を
                                                                                        住        所 〒
 1. 卒業証明書・・・・・・・・・・・・・・・・                             通
                                                                                 受
 2. 修了証明書・・・・・・・・・・・・・・・・                             通
 3. 成績証明書・・・・・・・・・・・・・・・・                             通           （連絡先電話番号）                                         
                                                                                 け
 4. 単位修得証明書・・・・・・・・・・・                                   通           ※在校生            生徒証明書番号
 5. 調査書・・・・・・・・・・・・・・・・・・・・・                       通                      学部
                                                                                 る
 6. 在学証明書・・・・・・・・・・・・・・・・                             通          第          学年           組：担任氏名
 
 7. 卒業見込証明書・・・・・・・・・・・                                   通    人     ※卒業生等          最終学年担任氏名
 8. その他（                                            ）                 通                          年         月    卒業 ・ 退学                       組
 
 
                                                         証明書申請受付簿兼発行決定簿
 
 収受印                                  保存期間                     年    分類記号                              文書の取扱い                              引
                                                                                                                                                            継
                                         宛       先                                                        発信者名                   校長²                 ぎ
 
                                         件       名           証明書等の発行について                        施     行            年        月        日
 
                                           本件について、                                                    決        定         年        月        日
 
                                                                                  許可する。                 起        案         年        月        日
                                           決 定 権 者           審   議    者        起     案   者         文書取扱主任              公 印 照 合
 
 
 
 
 文書記号
                                                       卒修成 単調在卒                                                       卒修成単 調 在 卒
   割 印                   番           号                                            割     印        番         号
                                                       業了績 位査学見                                                       業了績位 査 学 見