証明書発行申� �書（PDFファイ� ��）.pdf

Application for Certificate Issuance
Payment
（Applicant fills in the bold frame）
Arrears
Year
Month
Day
Purpose of use
Submission destination
Address
〒
1. Certificate of Enrollment
No.
2. Graduation Certificate
No.
3. Transcript
No.
(Phone number for contact)
4. Certificate of Earned Credits
No.
-
-
5. Investigation Report
No.
※(Graduates, etc.)
6. Expected Graduation Certificate
No.
7. Others
Year
Month
Department
Graduated/Dropped out
（ 　　　　　　　　 ）

Course
Fee
No.
No.
No.
No.
No.
No.
No.
No.
( ) No.
Year
Month
Day
To Principal Hori Kazuhiko, Gaisei Gakuen
Principal Suzuki Yasuhiro, Tachimi Nishi High School
Transcript
Others
Certificate of Earned Credits
Fee
Certificate of Enrollment
Investigation Report
Notification of payment for the above certificates
Graduation Certificate
Expected Graduation Certificate
Liberal Arts/Science
Notification
Handler
No.
S
H
Homeroom teacher's name in the final year
Seal
Certificate
Recipient
(Furigana)

Name
Birthdate
S・H Born on Year Month Day
Department Year Class
To Principal Tachimi Nishi High School
Date of application
Reiwa
We apply for the issuance of a certificate as follows.
Applicant's name
Principal
Clerk
Handler
Fee