Move to the text

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 and read QR cord, and please pay it to carrying as you 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. It becomes the issuance after the arrival of the price.
●Application, reference
〒Person in charge of 872-0032 Usa-shi, Oita 939, Esuka Yanagigaura High School office 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 communication 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
Piece/ ※Please input the number of need.
 The certificate format mentioned above
②Transcript
Piece/ ※Please input the number of need.
A deadline for before 1993 new student issuance: 20 years
 The certificate format mentioned above
③Certificate of student registration
Piece/ ※Please input the number of need.
 The certificate format mentioned above
④Being on the register roll period certificate
Please input the number of piece/need.
 The certificate format mentioned above
⑤Report of investigation
Please input the number of piece/need.
 The certificate format mentioned above
⑥Entering a dormitory certificate
Please input the number of piece/need. (only as for the Japanese sentence)
 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 date of birth ※required
/ /   
Age ※required
Year
The present address ※required
 
Graduation address
 
Phone number ※required
※A number to get of the communication is input surely in the daytime
FAX number
E-mail address ※required


Graduation time
/ / 
Course at the time of the graduation
(class) ※required
Payment method ※required
Remarks
※Special delivery hope
Yoshimochi Independent Academy Yanagigaura High School
〒872-0032
Usa-shi, Oita 939, Esuka
TEL.0978-38-0033
FAX.0978-38-5828
Back to TOP