証 明 書 発 行 申 請 書                                                     (記入例)
                                                                                           （申請者は太枠内を記入すること。）
                                                                                                                                                              全
  東京都立                      成瀬高等                  学校長¹ 殿             申請年月日                令和3 年           4     月 10 日
                                                                                                                                                              定
  下記により証明書の発行を申請します。                                          申請者氏名                       成    瀬          太     郎
 
 使用目的                                                                                                         な る せ         た ろ う              性別
                                                                                    （ ふりがな ）
 
                                                                               証        氏           名          成     瀬         太         郎        男
        ※       大学受験のため
        ※       就職先へ提出するため
                                                                               明        生 年 月 日            平成14       年    〇 月        △ 日生
        ※       奨学金の申請のため                            等
                                                                               を    住         所 〒 194-0044
  1. 卒業証明書・・・・・・・・・・・・・・・・                1         通
                                                                               受                    町田市成瀬7-4-1
  2. 修了証明書・・・・・・・・・・・・・・・・                          通
  3. 成績証明書・・・・・・・・・・・・・・・・                          通          （連絡先電話番号）                042              725     1533
                                                                               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              ○○ 先生
  8. その他（                                      ）                    通              令和3年 年 3 月 卒業 ・ 退学                         1        組
 
 
                                                  証明書申請受付簿兼発行決定簿
 収受印                               保存期間             1        年 分類記号               F400000 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