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）※前期申請者用 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 applied for the spring semester 学生番号 Student ID No. 氏　名 Name 提　出　書　類申請書類該当事項 Documents to be Submitted ①免除等申請にかかる申告書 Declaration Relating to the Application for Exemption of Tuition Fees ②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）全員提出書類 Students living alone: いずれ Documents to be か A copy of the residence card or a copy of alien registration one of submitted by all certificate the persons followi 住民票（同居者全員分） ng For all the family members living together with the applicant: Certificate of residence 前期申請から変 ③留学生生活調査書 Foreign Student Survey 更点のある人 Those who applied for the first half of the 2016 Academic ④私費外国人留学生生活実態調査票 Year, and have Self-supporting Foreign International Student Living Conditions Survey had changes since then . . チェック欄 Check □ □ □ □ □ 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 □ □ □