）□）） 日Day月Month年Year【様式 Form E-3】Foster mother□友人・知人Friend / AcquaintanceOrganization 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HusbandRelative of friend / acquaintanceRelative of business connection / personnel of local enterpriseForeign governmentJapanese 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 )(1)氏 名Name Applicant, legal representative or the authorized representative, prescribed in Paragraph 2 of Article 7-2.(1)氏 名NameName□その他 （□地方公共団体(2)本人との関係携帯電話番号Cellular Phone No.(2)本人との関係）□その他 （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□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□帰 国□日本での就職Find work in Japan28 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）(3)住 所Address電話番号Telephone No.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(3)住 所Address電話番号Telephone No.※ 取次者Agent or other authorized person(1)氏 名注意Attention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 applicant(representative) must correct the part concerned and sign their name.WifeFatherMotherUncle / AuntBusiness connection / Personnel of local enterprise Enter school of higher education in Japan Others□叔父 （伯父）・叔母（伯母）□受入教育機関Educational institution□取引関係者・現地企業等職員□日本国政府□日本での進学□その他 （(2)住 所Address(3)所属機関等Organization to which the agent belongsGrandfatherGrandmotherOthersLocal governmentRelationship with the applicantRelationship with the applicantFoster fatherOthers在留資格認定証明書用 For certificate of eligibility0463-58-1211受入教育機関職員東海大学〒259-1292 神奈川県平塚市北金目4-1-1携帯電話番号Cellular Phone No.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。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
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