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    担 当 者      令和        年
                                                                                                       第            号      年       月 日
                                                                                    月       日
 
 
                                              証 明 書 等 交 付 願
                                            卒業等した学校名       (座間総合・栗原・ひばりが丘)
                                     昭和                                                                                             卒   業
 卒業年月日・学科                    平成           年      月         日 全日・定時・通信制の課程                          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                                                                                                                            女
                                                                                                   平成
                                 （〒                      ）          TEL(                                                      )
 住                        所
 
 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
 
  上記のとおり交付を申請します。
                 令和            年           月           日
 
  神奈川県立座間総合高等学校長 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。