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Various Request for Issuance of Certificate forms

About the application from the website

When various certificates are applied for by the following form, you attach QR cord of (issuance fee + postage) for the price in the input e-mail address, and you save it for carrying and read QR cord, and please pay as you will reply. It becomes the issuance after confirming payment. In addition, please mail a stamp of (issuance fee + postage) for the price after the form input to the following request point as it becomes the procedure like the issuance of certificate by the mail when I cannot read QR code. Issuance tonarima after the arrival of the price ※The QR cord settlement (Pay Pay is available only for a meeting) 

Application, reference 〒 872-0032 939, Esuka, Oaza, Usa-shi, Oita 
Person in charge of Yanagigaura High School secretariat certificate issuance (Inquires phone number /TEL.0978-38-0033) 

Please inform me of the Inquires about our school by a telephone, fax, an email. You inquire it by an email, and an email may not arrive when there is not any contact in a few minutes either. Sorry for your inconvenience, but please refer to the phone number mentioned above. In addition, please feel free to contact us if you have any questions. ※As a reply email may not arrive, please cancel "designated reception" by email setting. Please inform me of the Inquires about our school by a telephone, fax, an email.
●Necessary certificate
※Please input the "number" of necessary certificates "format of Japanese and English". Please confirm whether there is not a mistake after the input by all means.
①Certificate of student registration
Piece/ ※Please input the number of need. (only as for the Japanese sentence)
②Entering a dormitory certificate
Piece/ ※Please input the number of need. (only as for the Japanese sentence)
③Graduation certificate with possibility
Piece/ ※Please input the number of need. (only as for the Japanese sentence)
④Transcript
Piece/ ※Please input the number of need. (only as for the Japanese sentence)
A deadline for before 1993 new student issuance: 20 years
⑤Report of investigation
Piece/ ※Please input the number of need. (only as for the Japanese sentence)
⑥Unit acquisition certificate
Piece/ ※Please input the number of need. (only as for the Japanese sentence)
⑦Certificate
Piece/ ※Please input the number of need.
 The certificate format mentioned above
●Information of the applicant
The name ※required
Furigana ※required
(Katakana)
Maiden name
※The change whom there was is required
Furigana
(Katakana)
※The change whom there was is required
Sex ※required
The name of an era (the date of birth) ※required
Year ※required
※Please choose it
The date of birth ※required
/   Please input born time.
Age ※required
Year
The present address ※required
 
Graduation address
 
Phone number ※required
※A number to get of the contact is input surely in the daytime
FAX number
E-mail address ※required


The graduation name of an era
The graduation year
Graduation month
Course at the time of the graduation
(class)
Payment method ※required
Remarks
※Request for special delivery
Yoshimochi Independent Academy Yanagigaura High School
〒872-0032
Usa-shi, Oita 939, Esuka
TEL.0978-38-0033
FAX.0978-38-5828
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