卒     2023年度入試     受験大学等【出願校調査表】（全日制卒業生用）                                調査書を請求するときに使用する用紙です
                                        20      年 3 月卒業 卒業時 3 年        組     番 氏名                           連絡先電話番号               （      ）          k
        調査書請求時提出                （            回生） 卒業時 学級担任                        先生                 連絡先メール                                        k
 ＊     調査書請求時  調査書を請求する際に、この用紙を提出してもらう必要があります。湘南高校HPからこの用紙を印刷して作成し、証明書等交付願と共に事務室に郵送して下さい。
 ＊     調査書請求時  上記の空欄、卒業年、卒業時、組・番・氏名、担任名、連絡先等をすべて記入して下さい。受験予定の大学¹等は、すべて記入して下さい。
 【記入上の注意】
 ＊     受験学校(大学²・短大等)名、学部(類、学群等)名、学科(学門、専攻等)名、入試方式、受験日、合格¹発表日をわかる範囲で正確に記入して下さい。
 ＊     入試方式欄には、前期、中期、後期、A方式、B方式、共通テスト利用、共通テスト併用、指定校推薦、総合型選抜（AO入試）、学校推薦型選抜（公募等）などを記入して下さい。
 ＊     大学³コードは、記入不要です。
 ＊     同じ大学⁴・学科を異なる入試日・方式で何度も受ける場合  欄を分けて 記入して下さい。
        第二志望の学科を記入して出願した場合（東工大など）     欄を分けず 学科名の所に、1情報工学2数理科学などと記入して下さい。（狭い欄ですが、詰めて書いてください）
 ＊     大学⁵入学共通テストを受験予定ならば「有」、受験予定がなければ「無」に○印を付けて下さい。
 ＊     合・否欄は、記入不要です。
 
  No.     学校コード        受験学校名          学部名                学科名            入試方式      受験日   発表日                  合・否                     備考   進学
                                                                                                                           1   2    3   4   5    6   1 0
  例 今回は記入不要          東京大学⁶          文科一類                                   前期         2/25     3/10      合・繰合・否・二・出・追・繰待
                                                                                                                           1   2    3   4   5    6   1 0
  1                                                                                                                      合・繰合・否・二・出・追・繰待
                                                                                                                           1   2    3   4   5    6   1 0
  2                                                                                                                      合・繰合・否・二・出・追・繰待
                                                                                                                           1   2    3   4   5    6   1 0
  3                                                                                                                      合・繰合・否・二・出・追・繰待
                                                                                                                           1   2    3   4   5    6   1 0
  4                                                                                                                      合・繰合・否・二・出・追・繰待
                                                                                                                           1   2    3   4   5    6   1 0
  5                                                                                                                      合・繰合・否・二・出・追・繰待
                                                                                                                           1   2    3   4   5    6   1 0
  6                                                                                                                      合・繰合・否・二・出・追・繰待
                                                                                                                           1   2    3   4   5    6   1 0
  7                                                                                                                      合・繰合・否・二・出・追・繰待
                                                                                                                           1   2    3   4   5    6   1 0
  8                                                                                                                      合・繰合・否・二・出・追・繰待
                                                                                                                           1   2    3   4   5    6   1 0
  9                                                                                                                      合・繰合・否・二・出・追・繰待
                                                                                                                           1   2    3   4   5    6   1 0
  10                                                                                                                      合・繰合・否・二・出・追・繰待
 
        大学⁷入学共通テスト受験予定の有無               有    ・     無     進路支援使用欄（2023                                       【                     】）
 No.    学校コード    受験学校名     学部名             学科名        入試方式   受験日   発表日             合・否                    備考   進学
                                                                                                   1   2   3   4   5   6   1 0
 例 今回は記入不要     東京大学⁸     文科一類                            前期     2/25      3/10    合・繰合・否・二・出・追・繰待
                                                                                                   1   2   3   4   5   6   1 0
 11                                                                                                合・繰合・否・二・出・追・繰待
                                                                                                   1   2   3   4   5   6   1 0
 12                                                                                                合・繰合・否・二・出・追・繰待
                                                                                                   1   2   3   4   5   6   1 0
 13                                                                                                合・繰合・否・二・出・追・繰待
                                                                                                   1   2   3   4   5   6   1 0
 14                                                                                                合・繰合・否・二・出・追・繰待
                                                                                                   1   2   3   4   5   6   1 0
 15                                                                                                合・繰合・否・二・出・追・繰待
                                                                                                   1   2   3   4   5   6   1 0
 16                                                                                                合・繰合・否・二・出・追・繰待
                                                                                                   1   2   3   4   5   6   1 0
 17                                                                                                合・繰合・否・二・出・追・繰待
                                                                                                   1   2   3   4   5   6   1 0
 18                                                                                                合・繰合・否・二・出・追・繰待
                                                                                                   1   2   3   4   5   6   1 0
 19                                                                                                合・繰合・否・二・出・追・繰待
                                                                                                   1   2   3   4   5   6   1 0
 20                                                                                                合・繰合・否・二・出・追・繰待
 
 
 
 特に以下の例に注意してください
 
 
 1    東工大等で【第3希望まで記入できる】場合
                                                  1情報理工
            「学部名」または「学科名」の欄に      2工 3生命理工
                                                                  のように記入してください。