記 入 要 領

グ ධ せ 㡿
㻱㼚㼠㼘㼥㻌㻳㼡㼕㼐㼑㼘㼕㼚㼑㼟
Ꮫ⏕␒ྕ
Student ID No.
ɐ ɍ 㻠 Ɏ ɔ ɕ ɕ ɕ
㸦ᵝᘧ␃㸯ձ㸧 )RUP5ձ㸧
ᤵᴗᩱච㝖⏦ㄳ᭩
‫ܖ‬ဃဪӭ≋≛ఐ≌⇁ᚡλↈ↺
ᖹᡂ䠎䠕 ᖺ‫ۑ‬᭶‫ۑ‬᪥
Application for Tuition Fee Exemption
ЭҞ஖Ў↞≗உ⅚ࢸҞ஖Ў↞‣•உྵ‫↝נ‬ཞඞ⇁ᚡλↈ↺⅛
※⁠⁖⁛⁕⁓⁦⁗‒⁦⁚⁗‒⁥⁛⁦⁧⁓⁦⁛⁡⁠‒⁓⁥‒⁡⁘‒″⁢⁤⁛⁞‒⁘⁡⁤‒⁦⁚⁗‒‣⁥⁦‒⁥⁗ ⁗⁥⁦⁗⁤‒⁓⁠⁖‒
⁁⁕⁦⁡⁔⁗⁤‒⁘⁡⁤‒⁦⁚⁗‒․⁠⁖‒⁥⁗ ⁗⁥⁦⁗⁤†
ᒸᒣ኱Ꮫ㛗ࠉẊ
Ꮫ㒊
Month
Day)
Ꮫ⛉࣭ㄢ⛬
(Faculty)
∀∙↭↎↞∂∞∑∀∙↖ᚡλↆ⅚ᚖദↈ↺‫ئ‬ӳ↞ʚஜዴ⇁
ࡽⅼ̲ദ෩↞̅ဇↆ↙ⅳↂ↗⅛
૜಺‫޻ݏ‬
ͤ ᦶ᧿䛻䜘䜚ᩥᏐ䛜ᾘ䛫䜛䝨䞁䠄䢈䢔䡴䡸䡪䢙䢉䢛䢙➼䠅䛷䛾グධ䛿
ㄆ䜑䜙䜜䜎䛫䜣䚹
⁉⁤⁛⁦⁗‒⁩⁛⁦⁚‒⁓‒⁢⁗⁠‒⁡⁤‒⁔⁓⁞⁞‟⁢⁡⁛⁠⁦„‒⁠⁡⁦‒⁩⁛⁦⁚‒⁢⁗⁠⁕⁛⁞‒⁡⁤ ⁗⁤⁓⁥⁓⁔⁞⁗‒⁛⁠⁝†
ిᅬ࿿ᅬ݂޻
◊✲⛉
(Graduate school)
(Department/C
䘟
‫ڧ‬༤ኈ๓ᮇㄢ⛬㸪ಟኈㄢ⛬
ᑓᨷ
‫ڧ‬༤ኈᚋᮇㄢ⛬㸪༤ኈㄢ⛬
੩Ј࠰உଐ⇁ᚡλↈ↺⅛
‷⁠⁦⁗⁤‒⁦⁚⁗‒⁖⁓⁦⁗‒⁡⁘‒⁥⁧⁔ ⁛⁥⁥⁛⁡⁠‒⁡⁘‒⁦⁚⁗‒⁓⁢⁢⁞⁛⁕⁓⁦⁛⁡⁠‒
⁖⁡⁕⁧ ⁗⁠⁦⁥†
The first half of the doctoral course / Master’s course
The second half of the doctoral course / Doctoral course
‫ڧ‬ᑓ㛛⫋Ꮫ఩
Professional degree
< Entered/Transferred to the university in April/October
39
ᖹᡂ
( Year )
⁉⁚⁗⁠‒⁡⁧‒⁕⁡⁤⁤⁗⁕⁦„‒⁖⁤⁓⁩‒⁦⁚⁗‒․‒⁞⁛⁠⁗⁥‒⁓⁕⁤⁡⁥⁥‒⁦⁚⁗‒⁗⁤⁤⁡⁤†‒‶⁡‒⁠⁡⁦‒
⁧⁥⁗‒⁩⁚⁛⁦⁗‟⁡⁧⁦†
䝣䝸䜺䝘
Ặࠉྡ
Name
ࠉࠉ
৑‫ܖ↝ޓ‬ᢿ⊦‫ܖ‬ᅹ≋ᄂᆮᅹ⊦‫ݦ‬ૌ⊦ᛢᆉ≌ ӏ↢
λ‫࠰ܖ‬உ⇁ᚡλↈ↺⅛
※⁠⁖⁛⁕⁓⁦⁗‒⁡⁧⁤‒‸⁓⁕⁧⁞⁦„‒‶⁗⁢⁓⁤⁦ ⁗⁠⁦„‒⁓⁠⁖‒⁩⁚⁗⁠‒⁡⁧‒
⁗⁠⁦⁗⁤⁗⁖‡⁦⁤⁓⁠⁥⁘⁗⁤⁤⁗⁖‒⁦⁡‒⁦⁚⁗‒⁁⁝⁓⁓ ⁓‒⁇⁠⁛⁨⁗⁤⁥⁛⁦†
(Year
Attention: President, Okayama University
ᖺ
(Year) >
䘟
‫ڧ‬᭶‫ڧ‬᭶
April
䝖䜴
/
䘟
‫ڧ‬ධᏛࠉࠉ‫⦅ڧ‬ධᏛ
October
Entered
/
䝅䝵䜴
Transferred
㸰 ࠉᖺḟ
๬ ̜̜ ਫ਼
ЭҞ஖Ў↞≗உ≔ଐ⅚ࢸҞ஖Ў↞≔≓உ≔ଐྵ
‫⇁࠰ܖ↝נ‬ᚡλↈ↺⅛
※⁠⁖⁛⁕⁓⁦⁗‒⁦⁚⁗‒⁙⁤⁓⁖⁗‒⁡⁘‒⁥⁦⁧⁖‒⁓⁥‒⁡⁘‒″⁢⁤⁛⁞‒‣‒⁘⁡⁤‒⁦⁚⁗‒
‣⁥⁦‒⁥⁗ ⁗⁥⁦⁗⁤‒⁓⁠⁖‒⁁⁕⁦⁡⁔⁗⁤‒‣‒⁘⁡⁤‒⁦⁚⁗‒․⁠⁖‒⁥⁗ ⁗⁥⁦⁗⁤†
( Grade )
ࡇࡢࡓࡧୗグ⌮⏤࡟ࡼࡾᖹᡂ䠎䠕ᖺᗘࠉ๓༙ᮇศᤵᴗᩱࢆච㝖ࡋ࡚
I hereby submit this application, together with related documents, to request exemption from the tuition fee payment for the first semester of the 2017 academic year
࠸ࡓࡔࡁࡓࡃ㛵ಀ᭩㢮ῧ௜ࡢୖ㸪࠾㢪࠸࠸ࡓࡋࡲࡍࠋ
due to the following reason:
グ
ࠉ⌮⏤
Reason:
੉ಅ૰βᨊ⇁ဎᛪↈ↺↚ᐱ→↎ʙऴ⇁⅚φ˳ႎ↚ᚡλↈ↺⅛
‶⁗⁥⁕⁤⁛⁔⁗‒⁕⁡⁠⁕⁤⁗⁦⁗⁞‒‒⁩⁚‒⁡⁧‒⁠⁗⁗⁖‒⁦⁡‒⁓⁢⁢⁞‒⁘⁡⁤‒⁓‒⁦⁧⁛⁦⁛⁡⁠‒⁘⁗⁗‒
⁗⁗ ⁢⁦⁛⁡⁠†‒
ɼ↎↺ܼᚘૅਤᎍⅻ⅚໯Ꮀ⅚‫ڂ‬Ꮀɶ↝‫ئ‬ӳ↞⅚
ⅳ↓ⅺ↸↌↝ཞඞ↚ⅱ↺↝ⅺ⅚ဃ෇ᝲ⇁↘↝↷
ⅵ↚᝺→↕ⅳ↺↝ⅺ⇁ᚡλↈ↺⅛
※⁘‒⁡⁧⁤‒ ⁓⁛⁠‒⁘⁓ ⁛⁞‒⁘⁛⁠⁓⁠⁕⁗‒⁥⁧⁢⁢⁡⁤⁦⁗⁤‒⁛⁥‒
⁧⁗ ⁢⁞⁡⁗⁖„‒⁛⁠⁖⁛⁕⁓⁦⁗‒⁩⁚⁗⁠‒⁦⁚⁗‒⁥⁛⁦⁧⁓⁦⁛⁡⁠‒⁥⁦⁓⁤⁦⁗⁖‒
⁓⁠⁖‒⁚⁡⁩‒⁡⁧⁤‒⁘⁓ ⁛⁞‒⁕⁡⁨⁗⁤⁥‒⁛⁦⁥‒⁕⁡⁥⁦⁥‒⁡⁘‒⁞⁛⁨⁛⁠⁙†
ࡑࡢᖺ᭶㸸
୺䛯䜛ᐙィᨭᣢ⪅䛜
↓⫋䞉ኻ⫋୰䛾ሙྜ
˞‫ܖ‬ഭⅻⅱ↺‫ئ‬ӳ↞ᚡλↈ↺⅛
※⁘‒⁡⁧‒⁚⁓⁨⁗‒⁩⁛⁦⁚⁖⁤⁓⁩⁠‒⁘⁤⁡ ‒⁥⁕⁚⁡⁡⁞‒⁦⁗ ⁢⁡⁤⁓⁤⁛⁞„‒
⁛⁠⁖⁛⁕⁓⁦⁗‒⁦⁚⁗‒⁢⁗⁤⁛⁡⁖‒⁓⁠⁖‒⁦⁚⁗‒⁤⁗⁓⁥⁡⁠†
From (month/year)
Source of living expenses:
ᖹᡂࠉᖺࠉࠉ᭶ࠉ᪥㹼ᖹᡂࠉࠉᖺࠉ᭶ࠉࠉ᪥
ఇᏛṔ䛾䛒䜛ሙྜ
Period (month/day/year) : From
If you have taken leave of absence from the university:
through
⌮⏤㸸
Reason:
ᖹᡂ㻞㻤ᖺᗘᚋ༙ᮇ䛾ᤵᴗᩱච㝖≧ἣ
ഛ䚷䚷䚷䚷䚷⪃
Previous exemption from tuition fee of last semester
ᐙ
᪘
Applicant
Family
ᮏ
ே
Half exempted
⌧ఫᡤ 䛈䚷䚷䚷㻙䚷㻌䚷䚷䚷㻚
Address
(PDLO
ఫᡤ
Rejected
Not
㼀㻱㻸
ᦠᖏ
Cell phone
㼀㻱㻸
Address
⏦ㄳ⤖ᯝ䛾㏻▱ඛ㻌䠄ᑒ⟄グධ䛾ᐄඛ䠅
Address for notification of the exemption decision
(The address indicated on the return envelope)
ஜʴ↝˰৑⊦ܼଈ↝˰৑≏↌↻↍↻↝ᡲዂέ
⇁ᚡλↈ↺⅛
‸⁛⁞⁞‒⁛⁠‒⁦⁚⁗‒⁓⁢⁢⁞⁛⁕⁓⁠⁦’⁥‒⁓⁖⁖⁤⁗⁥⁥‒⁓⁠⁖‒⁦⁚⁗‒⁕⁡⁠⁦⁓⁕⁦‒
⁖⁗⁦⁓⁛⁞⁥‒⁘⁡⁤‒⁗⁓⁕⁚‒⁘⁓ ⁛⁞‒ ⁗ ⁔⁗⁤†
Note
䘟
‫ڧ‬඲㢠ච㝖ࠉ‫༙ڧ‬㢠ච㝖ࠉ‫ڧ‬୙チྍࠉ‫⏦ڧ‬ㄳ↓ࡋ
Fully exempted
࠯঺․‪࠰ࡇࢸҞ஖↝੉ಅ૰βᨊ↝ཞඞ↚
⇧⇍⇩⇕‫↓⇁ݱ‬ↀ↺⅛
‵⁚⁗⁕⁝‒⁦⁚⁗‒⁤⁗⁥⁧⁞⁦‒⁡⁘‒⁦⁚⁗‒⁢⁤⁗⁨⁛⁡⁧⁥‒⁦⁧⁛⁦⁛⁡⁠‒⁘⁗⁗‒
⁗⁗ ⁢⁦⁛⁡⁠‒†
ᖹᡂࠉࠉࠉࠉᖺࠉࠉࠉࠉ᭶࠿ࡽ
Period out of work:
⏕ά㈝ࡢฟᡤ㸸
If the primary financial provider of the household is
currently out of work:
䘟
䕕ᮏேఫᡤ䚷䚷䕕␃Ꮫ⏕ᐟ⯋䚷䚷䕕䛭䛾௚䠄䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷䠅
Applicant’s address / Dormitory for international student / Other
ဎᛪኽௐ⇁ᡫჷↈ↺‫ݥ‬ለ↝ᡛ˄έ⇁ᢠ৸
ↈ↺⅛
‵⁛⁤⁕⁞⁗‒⁦⁚⁗‒⁓⁖⁖⁤⁗⁥⁥‒⁘⁡⁤‒⁥⁗⁠⁖⁛⁠⁙‒⁦⁚⁗‒⁠⁡⁦⁛⁘⁛⁕⁓⁦⁛⁡⁠‒⁡⁘‒
⁦⁚⁗‒⁦⁧⁛⁦⁛⁡⁠‒⁘⁗⁗‒⁗⁗ ⁢⁦⁛⁡⁠†
ܼࡊཞඞᛦ୿ ᚡλᙲ᪸
Application Guidelines for International Students’ Record of Family Status
‫ٽ‬௒ഇ↞≏‫ܖٻ‬ᛐ‫↰↎↝ܭ‬ᚡλↆ↙ⅳↂ↗⅛
‾⁗⁓⁨⁗‒⁦⁚⁗‒⁦⁚⁛⁕⁝‟⁔⁡⁤⁖⁗⁤⁗⁖‒⁔⁡⁗⁥‒⁔⁞⁓⁠⁝‒‚⁘⁡⁤‒⁓⁖ ⁛⁠⁛⁥⁦⁤⁓⁦⁛⁨⁗‒⁧⁥⁗‛
38
㻡
Ꮫ⏕␒ྕ ɐ ɍ 㻠 Ɏ ɔ ɕ ɕ ɕ
ᐙ䚷ᗞ䚷≧䚷ἣ䚷ㄪ䚷᭩
ᅛ
Ặ䚷䚷䚷䚷䚷ྡ
ಔ༴ࠚ࿞
ଆࢢᅫႶ୨
ኵ䜎䛯䛿ጔ
husband or wife
䚷
ᑵ
Ꮫ
⪅
䜢
㝖
䛟
ᐙ
᪘
∝‫ܖݼ‬ᎍˌ‫↝ٳ‬ဃᚘ⇁ɟ↚ↈ↺ܼଈ⇁ᚡλↈ↺⅛
∝ɼ↎↺ܼᚘૅਤᎍ↚ⅎҮ⅚К‫އ‬ᎍ↚⁷Ү⇁↓ↀ↺⅛
∝ྵ‫↝נ‬Ꮀಅഇ↞„˟ᅈՃ≏⋋⋠⊱⋅⋁⊳⋐⊱≏໯Ꮀ↝ܼଈ↞
Ⅴ໯ᎰⅥ↗ᚡλↈ↺⅛
∝‸⁛⁞⁞‒⁛⁠‒⁦⁚⁗‒⁠⁓ ⁗⁥‒⁡⁘‒⁘⁓ ⁛⁞‒ ⁗ ⁔⁗⁤⁥„‒⁡⁦⁚⁗⁤‒⁦⁚⁓⁠‒
ྠᒃ䛾ᐙ᪘䛿ྠ୍⏕
ᒃ䛾
䛾
⁥⁦⁧⁖⁗⁠⁦⁥„‒⁩⁚⁡‒⁥⁚⁓⁤⁗‒⁞⁛⁨⁛⁠⁙‒⁗⁢⁗⁠⁥⁗⁥†‒†
䛸䛧
䛧䜎
䛧
ィ䛸䛧䜎䛩䚹ྠᒃ䛾♽
∝⁂⁞⁓⁕⁗‒⁓⁠⃯ⅎ⃰ ⁠⁗⁦‒⁦⁡‒⁦⁚⁗‒⁢⁤⁛ ⁓⁤‒⁘⁛⁠⁓⁠⁕⁛⁓⁞‒⁢⁤⁡⁨⁛⁖⁗⁤‒∗ẕ➼䜒ྵ䜏䜎䛩䚹
ẕ➼
➼
⁡⁘‒⁦⁚⁗‒⁚⁡⁧⁥⁗⁚⁡⁞⁖„‒⁓⁠⁖‒⁓⁠⃯⁊⃰ ⁠⁗⁦‒⁦⁡‒ ⁗ ⁔⁗⁤⁥‒⁞⁛⁨⁛⁠⁙‒
ูᒃ⪅䛻㽢
⁥⁗⁢⁓⁤⁓⁦⁗⁞†
∝‶⁗⁥⁕⁤⁛⁔⁗‒⁦⁚⁗‒⁥⁢⁗⁕⁛⁘⁛⁕‒⁡⁕⁕⁧⁢⁓⁦⁛⁡⁠‒⁥⁧⁕⁚‒⁓⁥‒⁡⁘⁘⁛⁕⁗‒
⁩⁡⁤⁝⁗⁤‒⁡⁤‒⁓‒⁢⁓⁤⁦⃫⁦⁛ ⁗⁤†‒⁄⁗⁙⁓⁤⁖⁛⁠⁙‒⁓‒⁘⁓ ⁛⁞‒ ⁗ ⁔⁗⁤‒
⁩⁚⁡‒⁚⁓⁥‒⁠⁡‒⁜⁡⁔„‒⁖⁡‒⁠⁡⁦‒⁞⁗⁓⁨⁗‒⁦⁚⁗‒⁥⁢⁓⁕⁗‒⃯⁕⁧⁤⁤⁗⁠⁦‒
⁡⁕⁕⁧⁢⁓⁦⁛⁡⁠⃰‒⁔⁞⁓⁠⁝‭‒⁗⁠⁦⁗⁤‒⃯⁀⁡⁠⁗†⃰
཰
ᖹᡂ䠎䠔ᖺศ䚷⤥୚ᡤᚓ䛾※Ἠᚩ཰⚊䠄୍㒊ศ䠅
‒⁉⁛⁦⁚⁚⁗⁞⁖‒⁆⁓‒⁅⁞⁛⁢‒․•‣
‚⁥⁦⁧⁔‛
ᨭ䚷ᡶ
䜢ཷ䛡
䜛䚷⪅
ఫ 䠆༊ศ
ᡤ
ཪ
‫ࠊޛޢ‬඾޽ɶṺὊṺὊ
䛿
ᒃ
Ṻ
ᡤ
✀䚷䚷䚷ู
ᨭ䚷ᡶ䚷㔠䚷㢠
෇
ዅ
῱ ῠ
Ῡ Ί ῠ
ఒ
ே
⤥୚ᡤᚓ᥍㝖ᚋ䛾㔠㢠 ᡤᚓ᥍㝖䛾㢠䛾ྜィ㢠
෇
෇
෇
෇
ே
⪁ே
෇ே
㻜 㻜
䕧
㻜 㻜
㻔᦬せ㻕䚷䚷䚷䚷䚷䚷ᐃᖺ᥍㝖㢠䚷䚷䚷෇
䚷䚷䚷䚷䚷䚷䚷䚷䚷䚷ᖺᑡᢇ㣴䚷䚷䚷䚷㻌ே
㞀ᐖ⪅䛾ᩘ
㻔ᮏே䜢㝖䛟㻕
䛭䛾௚ ≉ู
䛭䛾௚
ே
෇ ே ே
㻜
㻜
㻜
㻜
♫఍ಖ㝤ᩱ
➼䛾㔠㢠
⏕࿨ಖ㝤ᩱ
䛾᥍㝖㢠
ᦆᐖಖ㝤ᩱ ఫᏯ೉ධ㔠➼
䛾᥍㝖㢠 ≉ู᥍㝖㢠
෇
෇
෇
㻜
㻜
㻜
෇
㻜
㓄അ⪅䛾ྜィᡤᚓ
㻜෇
ಶேᖺ㔠ಖ㝤ᩱ䛾㔠㢠
㻜෇
㛗ᮇᦆᐖಖ㝤ᩱ䛾㔠㢠
㻜෇
ↂ↝ഇ↝᣿᫇⇁Ⅴዅɨ৑ࢽⅥഇ↚ᚡλↈ↺⅛
※⁠⁖⁛⁕⁓⁦⁗‒⁦⁚⁛⁥‒⁓ ⁡⁧⁠⁦‒⁧⁠⁖⁗⁤‒⁗ ⁢⁞⁡ ⁗⁠⁦‒⁛⁠⁕⁡ ⁗
≾⤥୚ᡤᚓ䠹†
≧
ἣ
䠏䠌
࿶ ନ
䚷䚷䚷ᖺ䚷䚷䚷᭶䡚
㻞㻡
‫ܖ‬ဃ
䠎䠕
ᖺ
㻞㻜
グධ䛧䛺䛔䚹
㻟㻜
㻸㼑㼍㼢㼑㻌㼎㼘㼍㼚㼗㻚
᭶䡚
㻟㻡
㻠㻜
㻠㻡
㻡㻜
ᚡλ๨↻ⅻ↙ⅳ↷ⅵ↚ↆ↕ⅾ↏ↄⅳ⅛
䚷䚷䚷ᖺ䚷䚷䚷᭶䡚
Make sure all the items are filled in.
㻡㻡
㻢㻜
䚷䚷䚷ᖺ䚷䚷䚷᭶䡚
䚷䚷䚷ᖺ䚷䚷䚷᭶䡚
㻢㻡
㻣㻜
㻣㻡
㻤㻜
㻤㻡
㻥㻜
䚷䚷䚷ᖺ䚷䚷䚷᭶䡚
䚷䚷䚷ᖺ䚷䚷䚷᭶䡚
䚷䚷䚷ᖺ䚷䚷䚷᭶䡚
⥆᯶
༊ ศ
⤥
୚
ᡤ
ᚓ
咁
ὀ
䠍
咂
⤥
ᙺ
ᑓ
ᖺ
ኻ
ᩱ 䞉 ㈤
ဨ ሗ
ᚑ ⪅ ⤥
㔠 䞉 ᜠ
ᴗ ⤥ ௜
㔠
㓘
୚
⤥
㔠
ィ
ၟ 䞉 ᕤ ᴗ
⤥ ㎰ 䞉 ᯘ 䞉 ⁺ ᴗ
※㻌Ἠ㻌ᚩ㻌཰㻌㢠
ᵐᵒᵑᵊᵎᵎᵎ
ᢇ㣴ぶ᪘䛾ᩘ
㻔㓄അ⪅䜢㝖䛟㻕
≉ᐃ
ධ
Ե
ᵏᵊᵎᵏᵓᵊᵎᵎᵎ
᥍㝖ᑐ㇟㓄അ 㓄അ⪅≉ู
᥍㝖䛾㢠
⪁
䛾᭷↓
᭷↓
ᵓᴾᵖᴾᵋ ᵑᴾᵎᴾᵎ
㻔ཷ⤥⪅␒ྕ㻕
Ặ 㻔䢈䢔䡲䢚䢁㻕
ྡ
㻔ᙺ⫋ྡ㻕
㓄
അ
⪅
⤥୚ᡤᚓ䛾ィ ⤥୚ᡤᚓ௨እ䛾
䠄⛯㎸䠅䚷䠄༓෇䠅 ᡤᚓ㻔⛯㎸㻕㻔༓෇㻕
㻝㻡
๬ ਫ਼
ᮏே
⌧ᅾ䛾⫋ᴗ
㛤ጞᖺ᭶
ᖺ㱋
୚
ᡤ
ᚓ
௨
እ
䛾
ᡤ
ᚓ
咁
ὀ
䠎
咂
䛭
䛾
௚
䛾
㞧
ᡤ
ᚓ
ᐙ㈤䞉ᆅ௦
฼ Ꮚ 㓄 ᙜ
ෆ
⫋
ぶᡉ➼䛾᥼
ຓ
䜰 䝹 䝞 䜲 䝖
ᮏ㻌㻌ே
䠄༓෇䠅
ᵏᵊᵎᵏᵓ
䠄༓෇䠅
䠄༓෇䠅
䠄༓෇䠅
䠄༓෇䠅
䠄༓෇䠅
ഛ㻌⪃
䜰䝹䝞䜲䝖䛷⤥୚ᢅ䛔䛾཰ධ㻔※Ἠᚩ཰⚊䛜
䛒䜛䜒䛾䛺䛹㻕䛿䠈䛣䛾ḍ䛻グධ䛩䜛䚹
㻲㼕㼘㼘㻌㼕㼚㻌㼠㼔㼕㼟㻌㼟㼜㼍㼏㼑㻌㼒㼛㼞㻌㼕㼚㼏㼛㼙㼑㻌㼒㼞㼛㼙㻌㼍㻌㼜㼍㼞㼠㻙㼠㼕㼙㼑㻌
㼖㼛㼎㻌㻔㼕㻚㼑㻚㻌㼜㼍㼥㻌㼒㼛㼞㻌㼣㼔㼕㼏㼔㻌㼍㻌㼣㼕㼠㼔㼔㼑㼘㼐㻌㼠㼍㼤㻌㼟㼘㼕㼜㻌㼕㼟㻌
㼕㼟㼟㼡㼑㼐㻕㻚
㻝㻘㻜㻝㻡
⇈∑⇶⇊⇮↖ዅɨৢⅳ↖↙ⅳ↱↝↞≏ↂ↝ഇ
↚ᚡλↈ↺⅛
Enter in this space the income from part-time jobs
that are not categorized as employment income.
ᵑᵔᵎ
㏥ ⫋ 㔠
⮫ ಖ 㝤 㔠
᫬
ᡤ ㈨⏘ㆡΏᡤ
ᚓ ᒣ ᯘ ᡤ ᚓ
ィ
㻟㻢㻜
ὀ䠍䚷⤥୚ᡤᚓ䛿䠈๓ᖺ䠍ᖺ㛫䛾཰ධ㔠㢠䠄※Ἠᚩ཰⚊䛾ᨭᡶ㔠㢠➼䠅䜢グධ䛩䜛䛣䛸䚹䠄༓෇ᮍ‶ษᤞ䛶䠅
ὀ㻞䚷⤥୚ᡤᚓ௨እ䛾ᡤᚓ䛿䠈๓ᖺ㻝ᖺ㛫䛾཰ධ㔠㢠䛛䜙ᚲせ⤒㈝䜢᥍㝖䛧䛯㢠䜢グධ䛩䜛䛣䛸䚹䛯䛰䛧䠈
䚷䚷䚷㻌⮫᫬ᡤᚓ䛿䠈⏦ㄳ๓㻢䛛᭶㛫䛾཰ධ㔠㢠䜢グධ䛩䜛䛣䛸䚹䠄༓෇ᮍ‶ษᤞ䛶䠅
⁀⁡⁦⁗‒‣‬‒⁄⁗⁙⁓⁤⁖⁛⁠⁙‒⁗ ⁢⁞⁡ ⁗⁠⁦‒⁛⁠⁕⁡ ⁗„‒⁘⁛⁞⁞‒⁛⁠‒⁦⁚⁗‒⁓ ⁡⁧⁠⁦‒⁡⁘‒⁓⁠⁠⁧⁓⁞‒⁗⁓⁤⁠⁛⁠⁙⁥‒⁘⁡⁤‒⁦⁚⁗‒⁢⁤⁗⁨⁛⁡⁧⁥‒⁗⁓⁤‒‚⃯ૅ৚᣿᫇⃰‒⁍⁥⁚⁛⁚⁓⁤⁓⁛‟⁝⁛⁠⁙⁓⁝⁧⁏‒
⁛⁠⁖⁛⁕⁓⁦⁗⁖‒⁡⁠‒⁦⁚⁗‒⁩⁛⁦⁚⁚⁡⁞⁖⁛⁠⁙‒⁦⁓‒⁥⁞⁛⁢‒⁍เඡࣉӓᅚ ⁙⁗⁠⁥⁗⁠⁕⁚⁡⁥⁚⁧‟⁚⁡⁏„‒⁗⁦⁕†‛†‒‶⁛⁥⁤⁗⁙⁓⁤⁖‒⁘⁤⁓⁕⁦⁛⁡⁠⁥‒⁞⁗⁥⁥‒⁦⁚⁓⁠‒⁡⁠⁗‒⁦⁚⁡⁧⁥⁓⁠⁖‒⁗⁠†
⁀⁡⁦⁗‒․‬‒⁄⁗⁙⁓⁤⁖⁛⁠⁙‒⁛⁠⁕⁡ ⁗‒⁡⁦⁚⁗⁤‒⁦⁚⁓⁠‒⁗ ⁢⁞⁡ ⁗⁠⁦‒⁛⁠⁕⁡ ⁗„‒⁘⁛⁞⁞‒⁛⁠‒⁦⁚⁗‒⁓ ⁡⁧⁠⁦‒⁡⁔⁦⁓⁛⁠⁗⁖‒⁔‒⁖⁗⁖⁧⁕⁦⁛⁠⁙‒⁠⁗⁕⁗⁥⁥⁓⁤‒⁗⁢⁗⁠⁥⁗⁥‒⁘⁤⁡ ‒⁦⁚⁗‒⁓ ⁡⁧⁠⁦‒
⁡⁘‒⁓⁠⁠⁧⁓⁞‒⁗⁓⁤⁠⁛⁠⁙⁥‒⁘⁡⁤‒⁦⁚⁗‒⁢⁤⁗⁨⁛⁡⁧⁥‒⁗⁓⁤†‒⁄⁗⁙⁓⁤⁖⁛⁠⁙‒⁦⁗ ⁢⁡⁤⁓⁤‒⁛⁠⁕⁡ ⁗„‒⁘⁛⁞⁞‒⁛⁠‒⁦⁚⁗‒⁓ ⁡⁧⁠⁦‒⁡⁘‒⁛⁠⁕⁡ ⁗‒⁗⁓⁤⁠⁗⁖‒⁘⁡⁤‒⁦⁚⁗‒⁥⁛‒ ⁡⁠⁦⁚⁥‒⁔⁗⁘⁡⁤⁗‒
⁓⁢⁢⁞⁛⁕⁓⁦⁛⁡⁠†‒‶⁛⁥⁤⁗⁙⁓⁤⁖‒⁘⁤⁓⁕⁦⁛⁡⁠⁥‒⁞⁗⁥⁥‒⁦⁚⁓⁠‒⁡⁠⁗‒⁦⁚⁡⁧⁥⁓⁠⁖‒⁗⁠†
ܼࡊཞඞᛦ୿ ᚡλᙲ᪸
Application Guidelines for International Students’ Record of Family Status
䠄ᵝᘧ㻌␃䠍㻙䐠䠅 ᡫ‫ܖ‬ғЎ↞≏Ⅴ‣≝ᐯ‫ܡ‬Ⅵ↗↙↺⅛
䈜㻝㻝㻡
㏻Ꮫ༊ศ
ᮏ
㻌
ே
䠎䠕䚷ᖺ䚷ᗘ
ኵ
Ꮫ
ዡᏛ㔠
ཷ⤥≧ἣ
䚷ዡᏛ㔠ྡ⛠
䕿䕿䕿㈈ᅋዡᏛ㔠
䕿䕿䕿㈈ᅋዡᏛ㔠
᭶㢠䠄䠑䠌 㻌 䠅༓෇㽢䠄䠍䠎 㻌 䠅᭶
Ặ䚷㻌ྡ䠄ᖺ㱋䠅
タ⨨༊ศ
๓ᖺᗘዡᏛ㔠
ཷ⤥ᖺᗘ㢠
‵⁚⁡⁡⁥⁗‒Ⅴ‣≝‸⁓ ⁛⁞‒⁚⁡ ⁗Ⅵ†
䠄༓෇䠅
㻝㻝㻣
᭶㢠䠄䠑䠌 䠅༓෇㽢䠄䠍䠎 䠅᭶
㏻Ꮫ༊ศ
Ꮫ䚷㻌ᰯ䚷㻌✀䚷㻌ู
Ꮫ ᰯ ྡ 䠄 Ꮫ ᖺ 䠅
ᅦ
‫ݤ‬
‫ ܖٻޛޢ‬ඥ‫ܖ‬ᢿ
ί ὿ᾂᾃᾁᵕᴾᵶᵶᵶ ὸ
Ꮚ
䠎䠔䚷ᖺ䚷ᗘ
䚷ዡᏛ㔠ྡ⛠
ᑵ
⥆
㻌
᯶
䚷䚷䠍䠖⮬Ꮿ䚷䚷䚷㻌㻌㻌㻌䚷䠄䠎䠖⮬Ꮿእ䠅
ఒ
‫ݤ‬
‫ࠊޛޢ‬ᇌṺṺ‫ܖݱ‬ఄ
䈜㻝㻞㻞
䈜㻝㻞㻝
ᾁᾈ
䠄䚷䚷䚷䚷ᡯ䠅
ᵑ
䠄䚷䚷䚷䚷ᖺ䠅
䠍䠖ᅜ❧
䠎䠖බ❧
䠏䠖⚾❧
䈜㻝㻟㻜
䈜㻝㻞㻥
ᾆ
䠄䚷䚷䚷䚷ᡯ䠅
ᾀ
䠄䚷䚷䚷䚷ᖺ䠅
䠍䠖ᅜ❧
䠎䠖බ❧
䠏䠖⚾❧
䠄䚷䚷䚷䚷ᡯ䠅
䠄䚷䚷䚷䚷ᖺ䠅
䠍䠖ᅜ❧
䠎䠖බ❧
䠏䠖⚾❧
䠄䚷䚷䚷䚷ᖺ䠅
㻌䠍䠖ᑠᏛᰯ
㻌䠎䠖୰Ꮫᰯ
㻌䠏䠖㧗ᰯ
㻌䠐䠖኱Ꮫ
䈜㻝㻠㻢
䈜㻝㻠㻡
䠄䚷䚷䚷䚷ᡯ䠅
㻌䠍䠖ᑠᏛᰯ
㻌䠎䠖୰Ꮫᰯ
㻌䠏䠖㧗ᰯ
㻌䠐䠖኱Ꮫ
䈜㻝㻟㻤
䈜㻝㻟㻣
⪅
㻌䠍䠖ᑠᏛᰯ
㻌䠎䠖୰Ꮫᰯ
㻌䠏䠖㧗ᰯ
㻌䠐䠖኱Ꮫ
䠍䠖ᅜ❧
䠎䠖බ❧
䠏䠖⚾❧
㻌䠍䠖ᑠᏛᰯ
㻌䠎䠖୰Ꮫᰯ
㻌䠏䠖㧗ᰯ
㻌䠐䠖኱Ꮫ
䈜㻝㻞㻟
䠑䠖㧗➼ᑓ㛛Ꮫᰯ
䠒䠖ᑓಟᏛᰯ㧗➼
䠓䠖ᑓಟᏛᰯᑓ㛛
䠍䠖⮬Ꮿ
䠄䠎䠖⮬Ꮿእ䠅
䈜㻝㻟㻝
䠑䠖㧗➼ᑓ㛛Ꮫᰯ
䠒䠖ᑓಟᏛᰯ㧗➼
䠓䠖ᑓಟᏛᰯᑓ㛛
䠍䠖⮬Ꮿ
ʻ࠰ࡇ≔࠰᧓‚≗உ⊡≖உ‛↚Ӗዅↈ↺‫ܖڜ‬᣿≋ʖ‫ܭ‬
⇁ԃ↯≌↗Э࠰ࡇ↚Ӗዅↆ↎‫ܖڜ‬᣿↚↓ⅳ↕ᚡλↈ
↺⅛
※⁠⁖⁛⁕⁓⁦⁗‒⁦⁚⁗‒⁥⁕⁚⁡⁞⁓⁤⁥⁚⁛⁢‒⁔⁗⁠⁗⁘⁛⁦⁥‒⁡⁘‒⁦⁚⁛⁥‒⁓⁠⁖‒⁞⁓⁥⁦‒
⁗⁓⁤‚⁘⁤⁡ ‒″⁢⁤⁛⁞‒⁦⁡‒‿⁓⁤⁕⁚‛†
䠄䠎䠖⮬Ꮿ
䈜㻝㻟㻥
䠑䠖㧗➼ᑓ㛛Ꮫᰯ
䠒䠖ᑓಟᏛᰯ㧗➼
䠓䠖ᑓಟᏛᰯᑓ㛛
䠍䠖⮬Ꮿ
䠄䠎䠖⮬Ꮿ
䈜㻝㻠㻣
䠑䠖㧗➼ᑓ㛛Ꮫᰯ
䠒䠖ᑓಟᏛᰯ㧗➼
䠓䠖ᑓಟᏛᰯᑓ㛛
䠍䠖⮬Ꮿ
䠄䠎䠖⮬Ꮿ
㓄അ⪅➼䛜ᒸᒣ኱ᏛᅾᏛ䛾ሙྜ䛿䠈Ꮫ㒊䠄◊✲⛉䠅
ཬ䜃Ꮫ⏕␒ྕ䜢ేグ䛩䜛䚹
If the applicant’s sibling(s) is/are currently enrolled at
Okayama University, enter the name of their faculty
(graduate school) and student ID number.
኱
ᐙ㻌᪘㻌ᩘ
⊂❧⏕ィ
㻞㻝㻤
Ꮫຊ
⏦ㄳ༊ศ
㻞㻞㻝
Ꮫ
㻞㻞㻠
㸦㸮㸸 ↓ 㸧
㸮㸸୙㐺᱁
ㄆ
㸯㸸ヱᙜ
ᐃ
ே
㸯㸸㐺
᱁
㎡㻌㻌㻌㏥
㻞㻞㻣
グධ䛧䛺䛔䚹
Leave blank.
䚷䠍䠖୍⯡
䚷䠎䠖ᐙィ
䚷䠏䠖Ꮫຊ
䚷䠐䠖␃ᖺ㉸㐣➼
䚷䠑䠖ᐙィᨭᣢ⪅Ṛஸ
䚷䠒䠖⿕⅏
䛆‫ܖݼ‬ᎍⅩ↗↞≏
‫ܖݱ‬ఄ䞉ɶ‫ܖ‬ఄ㻔≉ูᨭ᥼Ꮫᰯ䜢ྵ䜐㻕≏᭗ሁ‫ܖ‬ఄ䠄㏻ಙไ䞉ᑓᨷ⛉䞉ู⛉䜢ྵ䜐䠅≏᭗ሁ‫ܖᧉݦ‬ఄ䠄ᑓᨷ⛉䞉ู⛉䜢ྵ䜐䠅≏
‫ܖٻ‬䠄኱Ꮫ㝔䞉ᑓᨷ䞉ู⛉䞉㏻ಙᩍ⫱㒊䜢ྵ䜐㻕㻌ӏ↢‫ܖ̲ݦ‬ఄ㻔㧗➼ㄢ⛬䞉ᑓ㛛ㄢ⛬䠅↚‫↕ↆܖנ‬ⅳ↺૾⇁ⅳⅳ↭ↈ⅛
൦င‫ܖٻ‬ఄ≏ᠾಅ‫ܖٻ‬ఄ≏ᎰಅᏡщ᧏ႆ‫ܖٻ‬ఄ≏᧸ᘓ‫ܖٻ‬ఄሁ ӏ↢ ‫ܖ̲ݦ‬ఄဃ㻔୍⯡ㄢ⛬㻕≏ᄂᆮဃ≏ᅹႸሁ‫̲ޗ‬ဃ≏
ᙀ፼ᅹဃ≏䛂Ӳᆔ‫ܖ‬ఄ䛃↚Ў᫏ↄ↻↺↱↝≋ʖͳఄ↳ᛖ‫ܖܖ‬ఄሁ≌↞≏‫ܖݼ‬ᎍ↚ᛆ࢘ↆ↙ⅳ⅛
↎↏ↆ≏‫ܖ̲ݦ‬ఄ‚‫ᧉݦ‬ᛢᆉ‛↝ᛐӧ⇁Ӗↀ↕ⅳ↺ᠾಅ‫ܖٻ‬ఄ↞‫ܖݼ‬ᎍ↚ᛆ࢘ↆ↭ↈ⅛
⃯⁅⁦⁧⁖⁗⁠⁦⁥⃰‒⁛⁠⁕⁞⁧⁖⁗‒⁦⁚⁡⁥⁗‒⁩⁚⁡‒⁓⁤⁗‒⁕⁧⁤⁤⁗⁠⁦⁞‒⁗⁠⁤⁡⁞⁞⁗⁖‒⁛⁠‒⁗⁞⁗ ⁗⁠⁦⁓⁤‒⁥⁕⁚⁡⁡⁞„‒⁜⁧⁠⁛⁡⁤‒⁚⁛⁙⁚‒⁥⁕⁚⁡⁡⁞‒‚⁛⁠⁕⁞⁧⁖⁛⁠⁙‒⁥⁕⁚⁡⁡⁞⁥‒⁘⁡⁤‒⁥⁢⁗⁕⁛⁓⁞‒⁠⁗⁗⁖⁥‒⁗⁖⁧⁕⁓⁦⁛⁡⁠‛„‒
⁚⁛⁙⁚‒⁥⁕⁚⁡⁡⁞‒‚⁛⁠⁕⁞⁧⁖⁛⁠⁙‒⁕⁡⁤⁤⁗⁥⁢⁡⁠⁖⁗⁠⁕⁗‒⁕⁡⁧⁤⁥⁗⁥„‒⁓⁖⁨⁓⁠⁕⁗⁖‒⁕⁡⁧⁤⁥⁗⁥„‒⁓⁠⁖‒⁥⁢⁗⁕⁛⁓⁞‒⁕⁡⁧⁤⁥⁗⁥‛„‒⁦⁗⁕⁚⁠⁛⁕⁓⁞‒⁕⁡⁞⁞⁗⁙⁗‒‚⁛⁠⁕⁞⁧⁖⁛⁠⁙‒⁓⁖⁨⁓⁠⁕⁗⁖‒⁕⁡⁧⁤⁥⁗⁥‒⁓⁠⁖‒⁥⁢⁗⁕⁛⁓⁞‒
⁕⁡⁧⁤⁥⁗⁥‛„‒⁧⁠⁛⁨⁗⁤⁥⁛⁦‒‚⁛⁠⁕⁞⁧⁖⁛⁠⁙‒⁙⁤⁓⁖⁧⁓⁦⁗‒⁥⁕⁚⁡⁡⁞⁥„‒⁓⁖⁨⁓⁠⁕⁗⁖‒⁕⁡⁧⁤⁥⁗⁥„‒⁥⁢⁗⁕⁛⁓⁞‒⁕⁡⁧⁤⁥⁗⁥‒⁓⁠⁖ ⁕⁡⁤⁤⁗⁥⁢⁡⁠⁖⁗⁠⁕⁗‒⁕⁡⁧⁤⁥⁗⁥‛„‒⁓⁠⁖‒⁥⁢⁗⁕⁛⁓⁞⁛⁗⁖‒⁦⁤⁓⁛⁠⁛⁠⁙‒⁕⁡⁞⁞⁗⁙⁗‒
‚⁛⁠⁕⁞⁧⁖⁛⁠⁙‒⁧⁢⁢⁗⁤‒⁥⁗⁕⁡⁠⁖⁓⁤‒⁕⁡⁧⁤⁥⁗⁥‒⁓⁠⁖‒⁥⁢⁗⁕⁛⁓⁞⁛⁗⁖‒⁕⁡⁧⁤⁥⁗⁥‛†‒
⁆⁚⁗‒⁘⁡⁞⁞⁡⁩⁛⁠⁙‒⁓⁤⁗‒⁠⁡⁦‒⁕⁞⁓⁥⁥⁛⁘⁛⁗⁖‒⁓⁥ 䇾⁅⁦⁧⁖⁗⁠⁦⁥䇿‬‒⁥⁦⁧⁖⁗⁠⁦⁥‒⁓⁦⁦⁗⁠⁖⁛⁠⁙‒⁀⁓⁦⁛⁡⁠⁓⁞‒‸⁛⁥⁚⁗⁤⁛⁗⁥‒⁇⁠⁛⁨⁗⁤⁥⁛⁦„‒⁓⁙⁤⁛⁕⁧⁞⁦⁧⁤⁓⁞‒⁕⁡⁞⁞⁗⁙⁗„‒⁢⁡⁞⁦⁗⁕⁚⁠⁛⁕‒⁧⁠⁛⁨⁗⁤⁥⁛⁦„‒
⁀⁓⁦⁛⁡⁠⁓⁞‒‶⁗⁘⁗⁠⁥⁗‒″⁕⁓⁖⁗ „‒⁥⁢⁗⁕⁛⁓⁞⁛⁗⁖‒⁦⁤⁓⁛⁠⁛⁠⁙‒⁕⁡⁞⁞⁗⁙⁗‒‚⁙⁗⁠⁗⁤⁓⁞‒⁕⁡⁧⁤⁥⁗⁥‛„‒⁢⁤⁗⁢⁓⁤⁓⁦⁡⁤‒⁥⁕⁚⁡⁡⁞„‒language school‭‒⁓⁠⁖‒⁤⁗⁥⁗⁓⁤⁕⁚‒⁥⁦⁧⁖⁗⁠⁦⁥†‒
⃸‒ЭҞ஖Ў⇁ဎᛪↈ↺‫ئ‬ӳ≏≖உҡಅ‚ᙸᡂ‛ӏ↢≗உλ‫ᙸ‚ܖ‬ᡂ‛↝Ωࢂሁ↚දॖↈ↺ↂ↗⅛
⃸‒≗உ↝ཞඞⅻச‫ئ↝ܭ‬ӳ↞≏ᙸᡂ↮↝ཞඞ⇁ᤲᇿ୿ⅼ↚ↆ≏ൿ‫ࢸܭ‬ᡮ↳ⅺ↚‫ފ‬ↀЈ↺ↂ↗⅛
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