）□）） 【様式 Form E-3】GrandmotherFoster fatherFoster mother□友人・知人Friend / AcquaintanceOthersOthers【様式 Form E-3】受入教育機関職員受入教育機関職員該当箇所をチェックしてください。Please put boxes.記入不要 Leave blank in the relevant 28 本邦における申請人の監護人（通学先が中学校又は小学校の場合に記入）28 本邦における申請人の監護人（通学先が中学校又は小学校の場合に記入）29 申請人，法定代理人，法第７条の２第２項に規定する代理人29 申請人，法定代理人，法第７条の２第２項に規定する代理人Relationship with the applicant (Check one of the followings when your answer to the question 26(1) is supporter living abroad or Japan)□夫□妻□父□母□祖父□祖母□養父□養母HusbandWifeFatherUncle / AuntRelative of friend / acquaintanceRelative of business connection / personnel of local enterpriseOrganization which provide scholarship (Check one of the following when the answer to the question 26(1) is scholarship) * multiple answers possible□外国政府Japanese governmentForeign government公益社団法人又は公益財団法人 （Public interest incorporated association /Public interest incorporated foundation27 卒業後の予定Plans after graduationReturn to home country Actual guardian in Japan ( Fill in the following if the applicant is to study at a junior high school or elementary school ) Actual guardian in Japan( Fill in the following if the applicant is to study at a junior high school or elementary school )(1)氏 名(1)氏 名NameName Applicant, legal representative or the authorized representative, prescribed in Paragraph 2 of Article 7-2. Applicant, legal representative or the authorized representative, prescribed in Paragraph 2 of Article 7-2.(1)氏 名(1)氏 名NameNameNameName□取引関係者・現地企業等職員□その他 （□地方公共団体□日本での進学□その他 （(2)本人との関係(2)本人との関係携帯電話番号携帯電話番号Cellular Phone No.Cellular Phone No.(2)本人との関係(2)本人との関係(2)住 所(2)住 所AddressAddress(3)所属機関等Organization to which the agent belongs(3)所属機関等Organization to which the agent belongs）□その他 （年年YearYear月月MonthMonth電話番号Telephone No.電話番号Telephone No.申請人等作成用 ３ Ｐ （「留学」）For applicant, part 3 P ("Student") (4)申請人との関係 （上記(1)で在外経費支弁者負担又は在日経費支弁者負担を選択した場合に記入）□兄弟姉妹Brother / Sister□叔父 （伯父）・叔母（伯母）□受入教育機関Educational institution□友人・知人の親族□取引関係者・現地企業等職員の親族(5)奨学金支給機関 （上記(1)で奨学金を選択した場合に記入）※複数選択可□日本国政府□帰 国□日本での就職Find work in JapanFind work in Japan(3)住 所(3)住 所AddressAddress電話番号電話番号Telephone No.Telephone No.(3)住 所(3)住 所AddressAddress電話番号電話番号Telephone No.Telephone No.※ 取次者Agent or other authorized person※ 取次者Agent or other authorized person(1)氏 名(1)氏 名注意注意申請書作成後申請までに記載内容に変更が生じた場合，申請人（代理人）が変更箇所を訂正し，署名すること。申請書作成後申請までに記載内容に変更が生じた場合，申請人（代理人）が変更箇所を訂正し，署名すること。In cases where descriptions have changed after filling in this application form up until submission of this application, the applicantIn cases where descriptions have changed after filling in this application form up until submission of this application, the applicantAttentionAttention(representative) must correct the part concerned and sign their name.(representative) must correct the part concerned and sign their name.東海大学東海大学〒259-1292 神奈川県平塚市北金目4-1-1〒259-1292 神奈川県平塚市北金目4-1-1携帯電話番号携帯電話番号Cellular Phone No.Cellular Phone No.I hereby declare that the statement given above is true and correct. I hereby declare that the statement given above is true and correct. 以上の記載内容は事実と相違ありません。以上の記載内容は事実と相違ありません。申請人（代理人）の署名／申請書作成年月日Signature of the applicant (representative) / Date of filling in this form 申請人（代理人）の署名／申請書作成年月日Signature of the applicant (representative) / Date of filling in this form 0463-58-12110463-58-1211MotherGrandfatherBusiness connection / Personnel of local enterpriseLocal government Enter school of higher education in Japan OthersRelationship with the applicantRelationship with the applicantRelationship with the applicantRelationship with the applicant在留資格認定証明書用 For certificate of eligibility日日DayDay─ 20 ─SAMPLE
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