卒
                                                                                                発送    月      日   郵送・直渡
                                                                 本人確認チェック：□免許証・保険証・学生証       □その他（    ）
      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        学務
  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   全日制課程                  普通科                  修了
                                                                                                                               退学
                                令和
        卒業時学級
        及び担任名
                                                                 組                      教諭
         ふりがな
 
                                                                                昭和
                                                                                                                               男
    卒業時氏名                                                                                                                 ・
                                                                                平成       年          月       日生
                                                                                                                               女
    英文で証明時使用する
    「スペリング」を記入
 
                           （〒                     ）
         現住所
                                                                                                  TEL
 
  証明書を必要と           □進学                □就職¹               □資格取得            □奨学生出願
      する理由             □外国留学            □高卒程度認定試験            □その他
                           卒業証明書                                              通
                           修了証明書                                              通      手数料
                           成績証明書                                              通              1通につき             400円
                           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
 上記のとおり交付申請します。
          令和             年               月            日
 神奈川県立綾瀬高等学校長                                   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。