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{"sheet":"長期履修書類","index":0,"n_rows":183,"n_cols":30,"rows_kept":183,"merged":[[1,0,1,29],[2,0,2,30],[6,12,6,20],[7,12,7,20],[8,12,8,20],[9,12,9,20],[10,12,10,20],[11,12,11,20],[13,2,13,26],[14,1,14,13],[15,1,15,28],[26,14,26,20],[27,14,27,20],[29,2,29,3],[29,5,29,27],[30,5,30,29],[31,5,31,20],[33,5,33,29],[34,5,34,29],[35,5,35,29],[36,5,36,29],[37,5,37,29],[38,5,38,29],[39,2,39,15],[43,2,43,29],[47,12,47,18],[58,4,58,20],[59,4,59,29],[64,4,64,7],[67,4,67,7],[70,4,70,7],[71,4,71,7],[74,4,74,7],[83,13,83,15],[96,1,96,29],[114,4,114,7],[115,4,115,29],[129,13,129,15],[137,0,137,29],[138,0,138,29],[140,14,140,18],[142,2,143,5],[142,6,143,27],[144,2,177,27],[178,1,178,3],[180,5,180,29],[182,5,182,29]],"flags":["formulas_cached_only"]}
[]
["長    期    履    修    願"]
["Request for Extension of Study Period"]
[]
[null,null,"広 島 大 学 長　　　　　　殿"]
[null,null,"To the President of Hiroshima University"]
[{"$nulls":12},"学　部・研究科\nSchool・Graduate School"]
[{"$nulls":12},"学科・課程・類・専攻/\nDepartment・Program・Cluster・Major"]
[{"$nulls":12},"入学年月/Admission date"]
[{"$nulls":12},"学生番号/Student Number"]
[{"$nulls":12},"氏　　　名/Name"]
[{"$nulls":12},"生年月日/Date of Birth"]
[]
[null,null,"私こと，下記理由により，　　　年　　 　月　  　　日から長期履修を申請します"]
[null,"ので，許可くださるようお願いいたします。"]
[null,"　I request permission for extension of study period from (Y          /M          /D          )  for the following reason(s)."]
[]
[{"$nulls":14},"記"]
[]
[{"$nulls":3},"卒業（修了）予定/New date of expected graduation (yyyy/mm)",{"$nulls":15}," 　　　年　　　月   "]
[]
[{"$nulls":3},"履修期間/Total period of study including extension",{"$nulls":15},"　 　　年（　        years)"]
[]
[{"$nulls":3},"理　　由/Reasons"]
[]
[]
[{"$nulls":14},"提出年月日/\nDate of Submission"]
[{"$nulls":14},"本人氏名/\nSignature of Student"]
[]
[null,null,"（注）",null,"１．","「履修期間」は，各学部・研究科が定める年限を限度とし，計画する期間を記入すること。"]
[{"$nulls":5},"In \"Total period of study including extension\" fill in a period that is less than or equal to the maximum limit."]
[{"$nulls":4},"２．","「氏名」及び「本人氏名」は，必ず学生本人が自署すること。"]
[{"$nulls":5},"The document must be signed by the student."]
[{"$nulls":4},"３．","職業を有し，かつ，就業している者（アルバイトとして就業する者を含む。）で，学修時間の確保が著しく困難であるものは，本学所定の在職証明書を添付すること。"]
[{"$nulls":5},"Individuals that are employed and working (including persons working part-time) for\nwhom securing time for study is especially difficult should attach a formal Hiroshima University certificate of employment."]
[{"$nulls":4},"４．","家庭において家事，育児及び介護を行う者は，本学所定の申立書に学修時間の確保が著しく困難である理由を具体的に記載し添付すること。\n"]
[{"$nulls":5},"Individuals that carry out domestic duties, childcare, or caregiving at home should fill out and attach a Hiroshima University \"Reasons for Requesting Extension of Study Period\" form, giving specific reasons why it is especially difficult to secure time for university study."]
[{"$nulls":4},"５．","身体障害，知的障害，精神障害(発達障害を含む。)その他の心身の機能の障害がある者は，心身の機能に障害があることを示す資料（障害者手帳の写し又は医師の診断書）を添付すること。"]
[{"$nulls":5},"Individuals with physical disabilities, intellectual disabilities, mental disabilities (including developmental disabilities), or other impairments of physical or mental functions must attach documentation indicating the presence of such disabilities (a copy of the disability certificate or a doctor's diagnosis)."]
[null,null,"指導教員（チューター）所見/Supervisor’s comments"]
[]
[]
[{"$nulls":16},"（署名/signature）"]
[null,null,"※記載された個人情報は，長期履修手続業務及び調査・統計を行う目的で利用するものであり，この目的以外で利用又は提供することはありません。\nPersonal information above will be used exclusively for extension of study period and for statistical purposes."]
[{"$nulls":21},"（広島大学長期履修願用）"]
[]
[]
[{"$nulls":12},"在職証明書"]
[]
[]
[]
[]
[{"$nulls":16},"氏　　名"]
[]
[{"$nulls":19},"　　　年　　月　　日生"]
[]
[]
[]
[{"$nulls":4},"上記の者は，下記のとおり在職していることを証明する。"]
[]
[]
[{"$nulls":14},"記"]
[]
[]
[{"$nulls":4},"採用年月日",{"$nulls":5},"　　　年　　　月　　　日"]
[]
[]
[{"$nulls":4},"勤務先所在地"]
[]
[]
[{"$nulls":4},"勤務時間",{"$nulls":4},"　","　　　時　　　　分　　～　　　　　時　　　　分"]
[{"$nulls":4},"（就業時間）",{"$nulls":5},"（曜日によって時間が異なる場合は，それごとに記入してください。）"]
[]
[]
[{"$nulls":4},"勤務休日",{"$nulls":5},"土曜日　・　日曜日　・　祝日　・　その他（　　　　　　　　　　　　　　）"]
[{"$nulls":10},"（該当するものに○印を付けてください。）"]
[]
[]
[]
[]
[{"$nulls":5},"　　　　年　　　　月　　　　日"]
[]
[]
[{"$nulls":13},"会社名等"]
[]
[{"$nulls":13},"代表者氏名",{"$nulls":14},"印"]
{"$rows_empty":8}
[{"$nulls":29},"(Regarding Request for Extension of Study Period)"]
[]
[null,"CERTIFICATE  OF  EMPLOYMENT"]
[]
[]
[]
[]
[{"$nulls":4},"Name",{"$nulls":6},":"]
[]
[{"$nulls":4},"Date of birth",{"$nulls":6},":"]
[]
[{"$nulls":4},"Starting date of work",{"$nulls":6},":"]
[]
[{"$nulls":4},"Office location",{"$nulls":6},":"]
[]
[{"$nulls":4},"Working hours",{"$nulls":6},":"]
[]
[{"$nulls":4},"Working holidays",{"$nulls":6},": "]
[]
[]
[]
[{"$nulls":4},"This is to certify that the above statement is true and correct."]
{"$rows_empty":7}
[{"$nulls":4},"Date",null,":"]
[]
[]
[]
[{"$nulls":17},"(Signature)"]
[]
[]
[{"$nulls":5},"（Official Seal）"]
[]
[]
[]
[]
[{"$nulls":22},"（広島大学長期履修願用）"]
[{"$nulls":29},"(Regarding Request for Extension of Study Period)"]
["長 　期　 履 　修 　申 　立 　書"]
["Reasons for Extension of Study Period"]
[]
[{"$nulls":14},"提出年月日\nDate of Submission",{"$nulls":8},"年",null,"月",null,"日"]
[]
[null,null,"氏名/name"]
{"$rows_empty":35}
[null,"（注/Note）",null,null,"１．","家庭において家事，育児及び介護を行うため学修時間の確保が著しく困難であることを，"]
[{"$nulls":5},"具体的に記載してください。"]
[{"$nulls":5},"Please specify why it is especially difficult to secure time for university study, with reasons such as the carrying out of domestic duties, childcare, or caregiving at home."]
[{"$nulls":4},"２．","注１で記載した内容に関する証明書，資料があれば提出してください。"]
[{"$nulls":5},"If available, please submit certificates and/or documentation relating to the content in Note 1."]

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[]
["長    期    履    修    願"]
["Request for Extension of Study Period"]
[]
[null,null,"広 島 大 学 長　　　　　　殿"]
[null,null,"To the President of Hiroshima University"]
[{"$nulls":12},"学　部・研究科\nSchool・Graduate School",{"$nulls":9},"○○学部"]
[{"$nulls":12},"学科・課程・類・専攻/\nDepartment・Program・Cluster・Major",{"$nulls":9},"○○学科"]
[{"$nulls":12},"入学年月/Admission date",{"$nulls":9},"平成３０年４月(yyyy/mm)"]
[{"$nulls":12},"学生番号/Student Number",{"$nulls":9},"B179999"]
[{"$nulls":12},"氏　　　名/Name",{"$nulls":9},"広大　太郎"]
[{"$nulls":12},"生年月日/Date of Birth",{"$nulls":9},"昭和５８年１月１０日"]
[]
[null,null,"私こと，下記理由により，平成 ３０　年　 ４ 　月　 １ 　日から長期履修を申請します"]
[null,"ので，許可くださるようお願いいたします。"]
[null,"　I request permission for extension of study period from (Y          /M          /D          )  for the following reason(s)."]
[]
[{"$nulls":14},"記"]
[]
[{"$nulls":3},"卒業（修了）予定/New date of expected graduation (yyyy/mm)",{"$nulls":15},"平成 ○○ 年　３　月   (yyyy/mm)"]
[]
[{"$nulls":3},"履修期間/Total period of study including extension",{"$nulls":15},"　 ５　年（　        years)"]
[]
[{"$nulls":3},"理　　由/Reasons",{"$nulls":5},"職業を有しており２年間で修了することが困難なため"]
[]
[]
[{"$nulls":14},"提出年月日/\nDate of Submission",{"$nulls":7},"平成３０年 ４ 月１０日"]
[{"$nulls":14},"本人氏名/\nSignature of Student",{"$nulls":7},"広大　太郎"]
[]
[null,null,"（注）",null,"１．","「履修期間」は，各学部・研究科が定める年限を限度とし，計画する期間を記入すること。"]
[{"$nulls":5},"In \"Total period of study including extension\" fill in a period that is less than or equal to the maximum limit."]
[{"$nulls":4},"２．","「氏名」及び「本人氏名」は，必ず学生本人が自署すること。"]
[{"$nulls":5},"The document must be signed by the student."]
[{"$nulls":4},"３．","職業を有し，かつ，就業している者（アルバイトとして就業する者を含む。）で，学修時間の確保が著しく困難であるものは，本学所定の在職証明書を添付すること。"]
[{"$nulls":5},"Individuals that are employed and working (including persons working part-time) for\nwhom securing time for study is especially difficult should attach a formal Hiroshima University certificate of employment."]
[{"$nulls":4},"４．","家庭において家事，育児及び介護を行う者は，本学所定の申立書に学修時間の確保が著しく困難である理由を具体的に記載し添付すること。\n"]
[{"$nulls":5},"Individuals that carry out domestic duties, childcare, or caregiving at home should fill out and attach a Hiroshima University \"Reasons for Requesting Extension of Study Period\" form, giving specific reasons why it is especially difficult to secure time for university study."]
[{"$nulls":4},"５．","身体障害，知的障害，精神障害(発達障害を含む。)その他の心身の機能の障害がある者は，心身の機能に障害があることを示す資料（障害者手帳の写し又は医師の診断書）を添付すること。"]
[{"$nulls":5},"Individuals with physical disabilities, intellectual disabilities, mental disabilities (including developmental disabilities), or other impairments of physical or mental functions must attach documentation indicating the presence of such disabilities (a copy of the disability certificate or a doctor's diagnosis)."]
[null,null,"指導教員（チューター）所見/Supervisor’s comments"]
[]
[{"$nulls":3},"○○○○○○○○・・・・"]
[{"$nulls":16},"（署名/signature）"]
[null,null,"※記載された個人情報は，長期履修手続業務及び調査・統計を行う目的で利用するものであり，この目的以外で利用又は提供することはありません。\nPersonal information above will be used exclusively for extension of study period and for statistical purposes."]
[{"$nulls":21},"（広島大学長期履修願用）"]
[]
[]
[{"$nulls":12},"在職証明書"]
[]
[]
[]
[]
[{"$nulls":16},"氏　　名",null,null,"広大　太郎"]
[]
[{"$nulls":19},"昭和　５８　年　１　月　１０　日生"]
[]
[]
[]
[{"$nulls":4},"上記の者は，下記のとおり在職していることを証明する。"]
[]
[]
[{"$nulls":14},"記"]
[]
[]
[{"$nulls":4},"採用年月日",{"$nulls":5},"平成　○○　年　○○　月　○○　日"]
[]
[]
[{"$nulls":4},"勤務先所在地",{"$nulls":5},"広島市○区○○町○丁目○○番○○号"]
[]
[]
[{"$nulls":4},"勤務時間",{"$nulls":4},"　","○○　時　○○　分　　～　　○○　時　○○　分"]
[{"$nulls":4},"（就業時間）",{"$nulls":5},"（曜日によって時間が異なる場合は，それごとに記入してください。）"]
[]
[]
[{"$nulls":4},"勤務休日",{"$nulls":5},"土曜日　・　日曜日　・　祝日　・　その他（　　　　　　　　　　　　　　）"]
[{"$nulls":10},"（該当するものに○印を付けてください。）"]
[]
[]
[]
[]
[{"$nulls":5},"平成　○○　年　○○　月　○○　日"]
[]
[]
[{"$nulls":13},"会社名等",{"$nulls":3},"○○○○○○学校"]
[]
[{"$nulls":13},"代表者氏名",{"$nulls":3},"○○○○○○学校長　　○　○　○　○",{"$nulls":10},"印"]
{"$rows_empty":8}
[{"$nulls":29},"(Regarding Request for Extension of Study Period)"]
[]
[null,"CERTIFICATE  OF  EMPLOYMENT"]
[]
[]
[]
[]
[{"$nulls":4},"Name",{"$nulls":6},":"]
[]
[{"$nulls":4},"Date of birth",{"$nulls":6},":"]
[]
[{"$nulls":4},"Starting date of work",{"$nulls":6},":"]
[]
[{"$nulls":4},"Office location",{"$nulls":6},":"]
[]
[{"$nulls":4},"Working hours",{"$nulls":6},":"]
[]
[{"$nulls":4},"Working holidays",{"$nulls":6},": "]
[]
[]
[]
[{"$nulls":4},"This is to certify that the above statement is true and correct."]
{"$rows_empty":7}
[{"$nulls":4},"Date",null,":"]
[]
[]
[]
[{"$nulls":17},"(Signature)"]
[]
[]
[{"$nulls":5},"（Official Seal）"]
[]
[]
[]
[]
[{"$nulls":22},"（広島大学長期履修願用）"]
[{"$nulls":29},"(Regarding Request for Extension of Study Period)"]
["長 　期　 履 　修 　申 　立 　書"]
["Reasons for Extension of Study Period"]
[]
[{"$nulls":14},"提出年月日\nDate of Submission",{"$nulls":5},"平成２６　",null,null,"年",4,"月",1,"日"]
[]
[null,null,"氏名/name",{"$nulls":3},"　　広大　太郎"]
{"$rows_empty":35}
[null,"（注/Note）",null,null,"１．","家庭において家事，育児及び介護を行うため学修時間の確保が著しく困難であることを，"]
[{"$nulls":5},"具体的に記載してください。"]
[{"$nulls":5},"Please specify why it is especially difficult to secure time for university study, with reasons such as the carrying out of domestic duties, childcare, or caregiving at home."]
[{"$nulls":4},"２．","注１で記載した内容に関する証明書，資料があれば提出してください。"]
[{"$nulls":5},"If available, please submit certificates and/or documentation relating to the content in Note 1."]