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                  若葉総合高等                 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
                                                                                    （ ふりがな ）                                                   性別
 
                                                                                         氏          名
                                                                               証
                                                                                         生 年 月 日                       年           月           日生
                                                                               明
                                                                                     住        所 〒
                                                                               を
  1. 卒業¹証明書・・・・・・・・・・・・・・・・                          通
  2. 修了証明書・・・・・・・・・・・・・・・・                          通    受
  3. 成績証明書・・・・・・・・・・・・・・・・                          通          （連絡先電話番号）                                      
  4. 単位修得証明書・・・・・・・・・・・                                通    け    ※在校生            生徒証明書番号
  5. 調査書・・・・・・・・・・・・・・・・・・・・・                    通                    学部
                                                                               る
  6. 在学証明書・・・・・・・・・・・・・・・・                          通          第        学年            組：担任氏名
  7. 卒業²見込証明書・・・・・・・・・・・                                通    人    ※卒業³生等          最終学年担任氏名
  8. その他（                                      ）                    通         ○をつけて下さい                若葉総合 ・ 稲城 ・ 南野
                                                                                                    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             1        年 分類記号                1年         文書の取扱い          F400000            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