平成２８年度入学料免除等申請提出書類チェック表【私費外国人留学生】（徴収猶予を含む） Checklist for Application Documents for Exemption, etc., of Admission Fees for the 2016 Academic Year ［Self-supporting Foreign Students］（Includes Collection Extension）申請書類該当事項受験番号 Examinee No. . 氏　名 Name . 提　出　書　類 Documents to be Submitted チェック欄 Check ①入学料（免除、徴収猶予）申請書 Admission Application Form (Exemption, Collection Extension) □ 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 Self-supporting Foreign International Student Living Conditions Survey Documents to be submitted by all 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） persons Students living alone: A copy of the residence card or a copy of alien registration いずれか one of certificate the 住民票（同居者全員分） For all the family members living together with the applicant: Certificate of residence □ □ following □ 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該当者のみ If applicable 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>) 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 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 □ □ いずれか one of the following 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 □ □ □