卒                                                                                              〔学校記入〕 郵送・直渡              年        月        日
                                                                                  領収日
 このことについて交付してよいでしょうか。                    発行担当・確認欄                 発行年月日             発行番号                 公 印
                                                                                  確認印
                                                                          事務      事務
   副校長      教 頭    総括教諭        担当教諭         事務長         担当者    担当者
                                                                                   年 月 日   年     月        日   第             号        年        月        日
 
 
 
 
                                   証 明 書 等 交 付 願
                            令和                                                                                                             卒 業
  卒業¹年月日・学科          平成                   年            月         日 全日制の課程            総合学科・普通科                      修 了
                            昭和                                                                                                             退 学
   卒業²学校、学級
                            金沢総合高等学校                   東金沢高等学校           富岡高等学校                          組                   教諭
     及び担任名
     ふりがな
                                                                                                                         年        月         日生
     卒業³時氏名
 
                        （〒                            ）
 
       住      所
 
                                                                  日中連絡がとれる電話番号                          （                  ）
 証明書を必要とす           □ 進学                 □ 就職               □ 資格取得              □ 奨学生出願
 る理由                     □ 外国留学 □ その他（                                                                           ）
 
 
                        卒業⁴証明書                                                通
                        修了証明書                                                通
                        成績証明書                                                通          手数料
                        単位修得証明書                                            通                                     1通につき                400 円
 証明書等の種類
                        推薦書                                                    通
                        その他(                                             )     通
 
 
                        調査書                                                    通                                     1通につき                500 円
 
 
                                                        計                         通                                     円
   上記のとおり交付を申請します。
        令和           年          月              日
 
   神奈川県立金沢総合高等学校長 様
                                                                                 氏 名
 
 
                                                                                                      ※学校記入欄 本人確認書類
 注意 証明書を必要とする理由の欄は、該当理由にレ点をつけてください。                                      運転免許証 保険証 マイナンバーカード
                                                                                                          （                                                 ）
                                                                                                          確認者                   年         月             日