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
                                                                       月        日
                                                                                                                  年 月        日
 
                                     証 明 書 等 交 付 願
   卒業年月日・             平成                                                                                         卒   業
                                           年    月          日 全日・定時・通信制の課程 普通 科                         修   了
       学科                 令和                                                                                         退   学
 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                                                                                                               女
                                                                                        平成
                          （〒                   ）
 住                  所
                                                                                      TEL
 
 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¹                    □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
 
                          発 行 不 能 通 知                                           通
 
  上記のとおり交付を申請します。
             令和         年         月          日
 
  神奈川県立               秦野曽屋             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。
 
 (学校使用欄)
                                                                            現金領収書No.
 □ 本人確認（免・保・パ・他                 ）
 □ 卒業後5年以下(調査書・成績証明)、20 年以下(単位)
 □ 進路アンケート(調査書の進学のみ)