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
 副 校 長     教    頭    事 務 長
                                     担 当 者   担 当 者        令和         年
                                                                                            第              号             年    月 日
                                                                       月         日
 
 
                                     証 明 書 等 交 付 願
                           昭和                                                                                                  卒   業
 卒業年月日・学科          平成                      年         月          日         全日制       普通科                       修   了
                                                                                                                                 退   学
                           令和
 卒 業 時 学 級
                                                                                 組                                        教    諭
 及 び 担 任 名
  ふ    り    が    な
                                                                                             昭和                                男
                                                                                                       年        月         日生 ・
 卒 業 時 氏 名                                                                              平成                                女
                          （〒                  ）                                     Tel
 住                 所
 
 
 証明書を必要 と            □進      学             □就            職           □資格取得             □奨学¹生出願
 す    る     理     由     □外国留学               □そ の 他
 
                                卒 業 証 明 書                                         通
                                修 了 証 明 書                                         通
                                                                                                    手数料
                                成 績 証 明 書                                         通
                                単位修得証明書                                         通             1 通につき                400 円
                                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
 
  神奈川県立上鶴間高等学校長 様
                                                           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。