平成２８年度後期分授業料免除等申請提出書類チェック表【私費外国人留学生】（後期分徴収猶予、月割分納を含む）※後期分のみ申請者用 Checklist for Application Documents for Exemption, etc., of Tuition Fees for the latter half of the 2016 Academic Year 【Self-supporting Foreign Students】 (Includes Collection Extension, Monthly Installment Payments) ※Those who did not apply for the first half of the 2016 Academic Year, but are going to apply for the latter half of the 2016 Academic Year 学生番号 Student ID No. 氏　名 Name 申請書類該当事項 . . チェック欄 Check 提　出　書　類 Documents to be Submitted ①授業料（免除、徴収猶予、月割分納）申請書 Tuition Application Form (Exemption, Collection Extension, Monthly Installment Payments) □ ②留学生生活調査書 Foreign Student Survey □ 全員提出書類 ③私費外国人留学生生活実態調査票 Documents to be Self-supporting Foreign International Student Living Conditions Survey submitted by all persons ④在留カードまたは外国人登録証明書のコピー（一人世帯の人） Students living alone: いずれ A copy of the residence card or a copy of alien registration か one of certificate 住民票（同居者全員分） For all the family members living together with the applicant: Certificate of residence the followi ng □ □ □ ⑤一緒に生活している人で高校、専門学校、各種学校、大学または大学院在学生のいる人 →　各学校長等が発行する「在学証明書」または学生証のコピー The certificate of student status or a copy of Student Identification Card (in cases where a person living together with the applicant is a student <excluding the applicant and students of elementary and junior high schools>) 該当者のみ If applicable ⑥給与支払証明書　【本学所定用紙】 Payment Certificate [university designated form] 平成２７年分の源泉徴収票のコピー copy of tax withholding slip for the 2015 fiscal year □ □ いずれか one of the following 最近３～６か月の給与明細書のコピー copies of the pay statements of the past 3 to 6 months ⑦申請受付窓口で提出を求められたもの Documents requested to be submitted at the application acceptance place □ □ □