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              調 布 南 高 等                     学校長¹ 殿         申 請 年 月 日 令和                    年          月            日
                                                                               申請者氏名
  下記により証明書の発行を申請します。
                                                                                 （続柄）
 使用目的
                                                                                   （ ふりがな ）                                                  性別
    1.      市役所等へ提出するため
                                                                              証        氏         名
    2.      親の勤務先へ提出するため
    3.      奨学金受給等のため                                                                            平成
                                                                              明        生 年 月 日                       年          月           日生
    4.      受験等のため                                                                                  昭和
 
    5.      その他（                                              ）          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
  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
                                                                                   平成・令和
  8. その他（                                      ）                  通                     年          月        卒業 ・ 退学                   組
                                                                                   昭和
 
 
                                                        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