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[]
["長   期   履   修   変   更   願"]
["Request for Change in 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　 　日から長期履修に係る"]
[null,"履修期間の変更（短縮）を申請しますので，許可くださるようお願いいた"]
[null,"します。"]
[null,"I hereby request a change in the extension of study period (Y          /M          /D          )  for the following reason(s)."]
[]
[{"$nulls":15},"記"]
[]
[]
[{"$nulls":3},"履修期間/\nTotal Periods of Study including extension",{"$nulls":13},"　　　　年 　→　　　　年\n（　      years →　　　　　years)"]
[]
[{"$nulls":3},"卒業（修了）予定/Date of expected Graduation",{"$nulls":13},"　　　年　　　月   (yyyy/mm)"]
[]
[{"$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，変更前及び変更（短縮）後の期間を記入すること。"]
[{"$nulls":5},"In \"Total Periods of Study Including Extension\", fill in the period before and after the change."]
[{"$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。"]
[{"$nulls":5},"The document must be signed by the student."]
[]
[null,null,"指導教員（チューター）所見/Supervisor’s comments"]
[]
[]
[{"$nulls":17},"（署名/Signature）"]
[null,"※記載された個人情報は，長期履修変更手続業務及び調査・統計を行う目的で利用するものであり，この目的以外で"]
[null,"利用又は提供することはありません。"]
[null,"Personal information above will be used exclusively for the change in extension of study period and for statistical purposes."]
[{"$nulls":21},"（広島大学長期履修変更願用）"]
[]
[{"$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"]
{"$rows_empty":10}
[{"$nulls":29},"(Regarding change in 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},":"]
[]
[{"$nulls":4},"Working holiday",{"$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)"]
[{"$nulls":17}," "]
[]
[{"$nulls":5},"（Official Seal）"]
[]
[]
[]
[]
[{"$nulls":29},"(Regarding change in Extension of Study Period)"]
[]
["長 　期　 履 　修 　申 　立 　書"]
["Reasons for Extension of Study Period"]
[]
[{"$nulls":14},"提出年月日\nDate of Submission",{"$nulls":8},"年",null,"月",null,"日"]
[]
[null,null,"氏名/name"]
{"$rows_empty":33}
[{"$nulls":3},"（注/Note）",1,"家庭において家事，育児及び介護を行うため学修時間の確保が著しく困難であることを，"]
[{"$nulls":5},"具体的に記載してください。"]
[{"$nulls":5},"Please specify why it is specially difficult to secure time for university study, with reasons such as the carrying out of domestic duties, childcare, or caregiving at home."]
[{"$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   変   更   願"]
["Request for Change in 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２７年４月(yyyy/mm)"]
[{"$nulls":12},"学生番号/Student Number",{"$nulls":9},"B159999"]
[{"$nulls":12},"氏　　　名/Name",{"$nulls":9},"西条　太郎"]
[{"$nulls":12},"生年月日/Date of Birth",{"$nulls":9},"平成10年10月30日"]
[]
[]
[null,null,"私こと，下記理由により，平成２９年　 ４　月　 １　日から長期履修に係る"]
[null,"履修期間の変更（短縮）を申請しますので，許可くださるようお願いいた"]
[null,"します。"]
[null,"I hereby request a change in the extension of study period (Y          /M          /D          )  for the following reason(s)."]
[]
[{"$nulls":15},"記"]
[]
[]
[{"$nulls":3},"履修期間/\nTotal Periods of Study including extension",{"$nulls":13},"　　６　年 　→　　５　年\n（　      years →　　　　　years)"]
[]
[{"$nulls":3},"卒業（修了）予定/Date of expected Graduation",{"$nulls":13},"平成　３１　年　３　月   (yyyy/mm)"]
[]
[{"$nulls":3},"理　　由/Reasons",{"$nulls":5},"研究計画が予定より早期に進んだため。"]
[]
[]
[{"$nulls":14},"提出年月日/\nDate of Submission",{"$nulls":7},"平成２９年 ４ 月１０日"]
[{"$nulls":14},"本人氏名/\nSignature of Student",{"$nulls":7},"広大　太郎"]
[]
[null,null,"（注）",null,"１．","「履修期間」は，変更前及び変更（短縮）後の期間を記入すること。"]
[{"$nulls":5},"In \"Total Periods of Study Including Extension\", fill in the period before and after the change."]
[{"$nulls":4},"２．","「氏名」及び「本人氏名」は，必ず学生本人が自署すること。"]
[{"$nulls":5},"The document must be signed by the student."]
[]
[null,null,"指導教員（チューター）所見/Supervisor’s comments"]
[]
[{"$nulls":3},"○○○○○○○○・・・・"]
[{"$nulls":17},"（署名/Signature）"]
[null,"※記載された個人情報は，長期履修変更手続業務及び調査・統計を行う目的で利用するものであり，この目的以外で"]
[null,"利用又は提供することはありません。"]
[null,"Personal information above will be used exclusively for the change in extension of study period and for statistical purposes."]
[{"$nulls":21},"（広島大学長期履修変更願用）"]
[]
[{"$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":10}
[{"$nulls":29},"(Regarding change in Extension of Study Period)"]
[]
[null,"CERTIFICATE  OF  EMPLOYMENT"]
[]
[]
[]
[]
[{"$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 holiday",{"$nulls":6},": "]
[]
[]
[]
[{"$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":17}," "]
[]
[{"$nulls":5},"（Official Seal）"]
[]
[]
[]
[]
[{"$nulls":29},"(Regarding change in 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２７",null,null,"年",4,"月",1,"日"]
[]
[null,null,"氏名/name",{"$nulls":3},"　　広大　太郎"]
{"$rows_empty":33}
[{"$nulls":3},"（注/Note）",1,"家庭において家事，育児及び介護を行うため学修時間の確保が著しく困難であることを，"]
[{"$nulls":5},"具体的に記載してください。"]
[{"$nulls":5},"Please specify why it is specially difficult to secure time for university study, with reasons such as the carrying out of domestic duties, childcare, or caregiving at home."]
[{"$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."]