卒業生用
                                                                                                                 合計                  通
                                               調査書交付願
                                                                                                                 ◎：合格¹入学
                                               指定校、推薦（公募）
                                                                 、推薦（自己）
                                                                             、AO                                ○：合格²
      国大、公大、私大
                                               私セ利用（A）
                                                          、私セ利用（B）
                                                                       、私セ利用（C）                           補◎：補欠入学
      国短、公短、私短
                                               一般入試、一般入試（A）
                                                                    、一般入試（B）
                                                                                 、一般入試（C）                 補○：補欠合格³
      国専、公専、私専
                                               一般入試（前）
                                                           、一般入試（後）
                                                                         、一般入試（全学）                      ×：不合格⁴
      大学校、その他
                                               国公（前）
                                                       、国公（後）
                                                                 、国公（中）
                                                                           、その他                              未：受験せず
 
 
         国公                                                        専攻           入試の         出願   受験     発表         手続締切    結
 No.                     学校名         学部           学科
         私他                                                       コース           方式          期間   月日     月日           月日      果
 
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 1                                                                                                         /         /             /
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 2                                                                                                         /         /             /
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 5                                                                                                         /         /             /
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 6                                                                                                         /         /             /
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 7                                                                                                         /         /             /
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 8                                                                                                         /         /             /
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 9                                                                                                         /         /             /
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 10                                                                                                        /         /             /
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   注意事項                                                        現住所・連絡先
   1 学校名等は「正式名称」を書く                                  〒       
   2 住所変更、受験先変更、結果は必ず報告する。
   3 この用紙の他に証明書発行申請書も記入・提出する。              Tel                        
 
 
 
 
 平成            年 3 月卒業      期生 卒業時担任                先生        組          番 氏名