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GLOBAL LEARNING CENTER,
TOHOKU UNIVERSITY

Certificate Request Form/証明書発行願

Personal Information/個人情報

Name in English

氏名(英語表記)

Family Name(氏): First Name(名):
E-mail Address

Student ID

学籍番号

Date of Birth

生年月日

(YYYY/MM/DD)

Department at Tohoku

東北大学での所属

Program

プログラム

If other, please specify:

Period of Enrollment

在学期間

From / To  /

Type of Certificate/証明書の種類

Certificate of Enrollment

在学証明書

No. of copies(枚数): English(英文): / Japanese(和文):

Academic Transcript

成績証明書

No. of copies(枚数): English(英文): / Japanese(和文):

Certificate of JASSO Student Exchange Support ProgramJASSO

奨学金受給証明書

No. of copies(枚数): Written in both English and Japanese(日英併記)

Other Certificate

その他

Type of certificate you need(必要な証明書):

If you have your own form, please upload here(独自のフォームがある場合はここからアップロード): ×

Purpose of Use

使用目的

Where to submit the requested certificates

提出先

How to receive/受取方法

How to Receive

受取方法

*You are responsible for postage(送料本人負担)

Where to pick up at the Student Exchange Division(留学生課での受取場所): PDF [Map]

E-mail Address

Mailing Address

送付先

(Only if you want to receive certificate(s) by post/郵送希望の場合のみ)

Special Request

コメント

 

Only if you want to receive certificate(s) by post/郵送希望の場合のみ

Do the certificates need to be sealed?(証明書は厳封の必要がありますか?) If yes, please explain how(厳封の場合、厳封方法):

Note

If you wish to have the requested certificates sent by post, you are responsible for postage. The Incoming Student Exchange Section will contact you regarding the postage separately.

証明書の郵送を希望する場合、送料はご本人負担になります。送料等は留学生交流係より別途ご連絡いたします。

Contact/連絡先

Incoming Student Exchange Section, Student Exchange Division, Tohoku University 41 Kawauchi, Aoba-ku, Sendai JAPAN 980-8576

〒980-8576 宮城県仙台市青葉区川内41 東北大学 教育学生支援部 留学生課 留学生交流係

Tel: +81-22-795-3775

Fax: +81-22-795-7826

Email: studyab@grp.tohoku.ac.jp