様式                                                                    （郵送用）        【記載例】                                                               （郵送用）
 
 
                    卒 業 証 明 書 交 付 願                                                                 卒 業 証 明 書 交 付 願
                                              令和         年      月     日                                                              令和 4 年 10 月 5 日
    愛知県立春日井西高等学校長 殿                                                              愛知県立春日井西高等学校長 殿                            分かれば記入
                                                                                                                                                        してください。
             昭和                                                                                    昭和
             平成                                                                                    平成
             令和           年 3月 普通科卒      組                                                  令和   8        年 3月 普通科卒 6 組
 
                                              昭和                                                                                        昭和
             氏名                             平成          年     月   日生                         氏名    春日井 西太郎                平成        52 年 9月 19日生
                ※氏名（英語版の場合ご記入ください）                                  切                ※氏名（英語版の場合ご記入ください）
 
                                                                                      り
             住所 〒                                                                                 住所 〒 460-0808                   英語版の場合、ご記入のローマ字
                                                                                      取                                                表記で交付いたします。
                                                                                                                                        <例>Kasugai Seitarouなど
                                                                                      り             春日井市田楽町1320番地
 
             電話                         携帯                                        線             電話    0568-32-9631             携帯    090-1234-5678
 
                                                                                                                                                 昼間連絡のとれる電話番
             下記により卒業¹証明書を交付して下さい。                                                                              号を記入してください。
                                                                                                     下記により卒業²証明書を交付して下さい。
                                         記                                                                                        記
 
    1 交付理由                                                                                 1 交付理由            大学受験のため
 
    2 必要部数                           部 （ 日本語版 ・ 英語版 ）                          2 必要部数                   1        部 （ 日本語版 ・ 英語版 ）
 
 
                                  発 行 台 帳                                                                              発 行 台 帳
        決             取                             発    令和         年                     決              取                               発     令和        年
                                   No.                                                                                       No.
        裁             扱                             行           月     日                    裁              扱                               行            月    日