卒
        このことについて交付してよいでしょうか。                            発行年月日         発行番号            公          印
                                                     事 務       教 務
  校    長          副校長    教    頭    事務長
                                                     担当者      キャリア
                                                                            令和                                  令和
                                                                                              第             号
                                                                              年 月 日                              年    月 日
 
 
 
                                          証 明 書 等 交 付 願
                               昭    和                                                                                   卒    業
 卒業¹年月日・学科              平    成
                                               年       月        日 全日・定時・通信制の課程 普通科                      修    了
                               令    和                                                                                   退    学
 卒 業 時 校                         逗子高等学校
 名 及 び 学                         逗葉高等学校                                        組                  教    諭
 級 、 担 任 名                      逗子葉山高等学校
       ふ    り が な
 
 
                                                                                       昭和                                    男
                              ※英文の証明書を申請する方は氏名をローマ字で(      )内                                           ・
 卒 業 時 氏 名                                                                        平成        年        月     日生       女
                              に記入してください。
 
                              （                                                 ）
                              （〒                   ）                            電話番号             （         ）
 
 住                      所
                              □卒業²時の住所地から転居しています。
                              ※調査書にはマンション名等は記載いたしません。
 証明書を必要 と □進                     学              □就        職       □資格取得           □奨学生出願
 す         る     理    由   □外国留学                  □その他（                                                           ）
 
                              卒 業 証 明 書                                           通
                                                                                              手数料
                              修 了 証 明 書                                           通
                                                                                                   1 通につき            400 円
                              成 績 証 明 書                                           通
                              単位修得証明書                                           通
                              児童（生徒・学生）
 証明書等の種 類              健 康 診 断 票 の 写 し
                                                                                       通
                              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
 
  神奈川県立逗子葉山高等学校長 殿
                                                      氏         名
 
 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
             免許証、保険証等により、本人確認をさせていただきます。