椙山女学園高校(愛知県)の公式サイト内のPDFをテキストに変換して表示しています。

このコンテンツは、受験生と保護者の皆様の利便をはかるため取得されました。
取得日:2019年12月10日[更新]

最新コンテンツは、下記の公式サイトURLにて、ご確認ください。
志望校の選定など重要な判断の際には、必ず最新の情報をご確認ください。
http://www.sugiyama-u.ac.jp/high/assets/docs/2018tyousasyo.pdf

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                                                                                                                  ・・・・・・・・・・・・
                                                                                                                                                                                                                                               先生 証明書の作成をお願いします。
                                      卒業生 調査書・推薦書 交付願                                    様式5
 ☆        太枠内を黒ボールペンでご記入ください。                     (右ページも同様に記入→)
 ☆        調査書有効期間は一般的に3ヶ月間です。出願期間を確認してから申し込んでください。                                                                                                                                                卒業生 進 路 調 査 票(教員用)
 ☆        高等学校は指導要録(指導の記録)の保存義務期間が5年間のため、調査書と成績証明書の発行は
           卒業後5年間に限らせていただいております。
                                                                                                                                                                                                         申込日 平成        年    月      日
 ☆        調査書等の提出先が決まっているものについて申し込み可能です。未定の分を余分に発行するこ
           とはできません。なお、交付後の取り消し・返金はいたしかねますのでご了承ください。                                                                                                              中学校・高等学校                                                 卒業時クラス・担任
      申込日 平成        年    月       日                                                                                                                                                               昭和・平成       年   月   日卒業                                3年     組                        先生
      中学校・高等学校                                                 卒業時クラス・担任                                                                                                                ふ       り   が   な                                            氏名変更された方
      昭和・平成       年   月   日卒業                                3年     組                      先生                                                                                              卒業時氏名                                                       現氏名
                                                                                                                                                                                                         英文証明書が必要な方はローマ字氏名(                                                                 )
                                                                       氏名変更された方
 
 
 
 
                                                                                                                   領収印
      ふ    り    が   な
                                                                                                                                                                                                                                       昭和
      卒業時氏名                                                       現氏名                                                                                                                             生年月日
                                                                                                                                                                                                                                       平成             年           月            日生まれ
      英文証明書が必要な方はローマ字氏名(                                                                    )
                                                                                                                                                                                                                                      〒       
       生年月日                    昭和・平成               年          月        日生まれ                                                                                                                    現住所
 
 
 
 
                                                                                                                   ・・・証明料領収後、事務で切り取り・・・・・・・・・・・・・・・・・・・・・・
                                 〒                                                                                                                                                                       電話番号                    (            )          
           現住所
                                                                                                                                                                                                          受取方法                      来校予定         月   日 /         郵送希望          月         日まで
       電話番号                  (            )                                                                                                                                                    *受験型はAO・センター・A日程・地方試験・前期など、具体的に書いて下さい。
                                 受験・就職・資格取得・入学手続き・奨学1金申請・            ←○をつける                                                                                              *提出先記入欄が足りない場合は、2枚目に氏名と下の提出先のみご記入ください。
       使用目的                                                                                                                                                                                      *推薦書が必要な場合は、「推薦願」も提出してください。
                                 その他具体的に(                                                  )
           提出先                                                                                                                                                                                                       1. 調 査 書                           枚
      ○○大学△△                                                                                                                                                                                                      2. 推 薦 書                           枚
      学部など具体
                                                                                                                                                                                                                        3. その他(                           )              枚
      的に
                                                                                                                                                                                                                                                                                                   出願
                                                                                                                                                                                                         提出先                  校    名          学    部        学科・専攻        受験型                  合否
      受取方法              来校予定    月    日 / 郵送希望                         月        日まで                                                                                                                                                                                              締切日
                        下記により、証明書を交付してください。
                                                                                                                                                                                                              1                                                                                     /
                                              発       行        台      帳
                                                                                                                                                                                                              2                                                                                     /
 英文証明書希望の場合は英文と明記してください。
      ↓           種       類         枚数     料金                   発行番号 及び 契印                                                                                                                     3                                                                                     /
 
                 調査書 200 円                              過          過        過            過                                                                                                            4                                                                                     /
 
                 推薦書 100 円                              過          過        過            過
                                                                                                                                                                                                         就職                    事業所名
                                                            過          過        過            過
                                                                                                                                                                                                     作成教員 注意事項
                  証明料合計                                                                                                                                                                        ・    推薦入学の場合は校名の前の数字を○で囲む。
                                                                                                                                                                                                    ・    自己推薦など学校推薦と異なる推薦については適宜わかる表現を添える。
                  郵        送    料                        郵送料は事務室で確認(052-751-8131)                                                                                                    ・    合否欄は、合格は○、不合格は×、最終進学先は◎を記入。
                                                                                                                                                                                                    ・    合否、入学等が決定後、この用紙を進路指導係まで提出
                                                    発行日: 平成                 年           月         日
                       領収印
                                                                        郵送返却:        月         日発送