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        FAX番号：0774-65-8990
           番号：0774-65-8990
                                                                                               記入日 20                  年      月          日
 
                                     【卒業生用】 証 明 書 交 付 願
 希望する証明書にチェック()をしてください
 
                              年度卒業            （3年              組         番）
 
 
    □             和文証明書                   氏 名
                                                                  （ローマ字）
    □             英文証明書                   Name
 
     生年月日                  （西暦）                      年                      月                  日生        満（                歳）
 
 
     提 出 先
  使 用 目 的                        留学¹                   ・入試     ・ その他（                                                               ）
     （○をつけてください）
 
 
                 証 明 書                                          通 数                      手 数 料                  手 数 料 小 計
             卒業証明書
         Certificate of Graduation
                                                                                     通     100円／通                                        円
 
             成績証明書
                                                                                     通     100円／通                                        円
                Transcript
                 調査書
                                                                                     通     100円／通                                        円
            School Record
             在籍証明書
     Certificate of Previous Enrollment
                                                                                     通     100円／通                                        円
 
                 推薦書
                                                                                     通
     Letter of Recommendation
 
  その他（                                 ）                                        通                                                         円
 
                       計                                                            通                                                         円
 
                                〒              -
    連 絡 先
                                          （TEL）
                                     □         郵送での受け取り                          ※上記、連絡先へ送付
     受取方法
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                                     □         窓口での受け取り                             予定日（           月           日）
 
 学校記入欄
         受       付             教務C           事務室                領 収 印
 
 
 
 
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