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                       篠崎高等                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
                                                                                 （ ふりがな ）                                                   性別
 
                                                                            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    る              学部
  6. 在学証明書・・・・・・・・・・・・・・・・                       通          第        学年            組：担任氏名
                                                                            人
  7. 卒業見込証明書・・・・・・・・・・・                             通          ※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