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 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¹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²見込証明書・・・・・・・・・・・                              通          ※卒業³生等          最終学年担任氏名
  8. その他（                                       ）                 通                         年         月 卒業⁴ ・ 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                 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