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["（様式第１号）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受付番号"]
["(Form No.1)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"-"]
[]
["千葉大学国際交流会館入居申請書"]
["APPLICATION FOR ADMISSION TO CHIBA UNIVERSITY INTERNATIONAL HOUSE"]
[null,null,null,null,null,null,null,null,null,null,null,"         Date:",null,null,"年",null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"     ","Year"," "," Month"," ",null,"Day"]
["　千葉大学国際交流会館長　殿"]
["　　To:The Director,Chiba University International House"]
[]
["申請者Applicant"]
["氏名\nName","フリガナ（Katakana）",null,null,null,null,null,null,null,null,null,null,null,null,"性別\nSex"]
[null,"英字または漢字"]
[null,"Block letters or Kanji"]
["生年月日  Date of birth",null,null,null,"年",null,"月",null,"日","年齢\nAge",null,null,null,"国籍\nNationality"]
[null,null,null,null,"Year",null,"Month",null,"Day"]
[]
["下記のとおり千葉大学国際交流会館への入居を希望しますので申請します。"]
["I hereby apply for admission to Chiba University International House."]
[]
["記"]
["１．学部・研究名\nName of faculty・graduate school",null,null,null,null,null,null,null,null,null,null,null,null,null,"年次\nGrade"]
["２．所属身分\nStatus"]
[]
["３．留学区分\nStatus of students"]
[]
[]
["４．指導教員又は受入担当教員\nAcademic advisor"]
["５．入居期間\nPeriod of stay in International House ",null,2019,"年",4,"月",1,"日","から",null,2019,null,"年",8,"月",30,"日","まで"]
[null,null,null,"Year ",null,"Month",null,"Day","From   ",null,null,null,"Year",null,"Month",null," Day","To  "]
["６．入居希望居室\nDesired type of room"]
["７．同居家族\nAccompanying family ",null,"氏名\nName",null,null,null,null,null,null,null,null,"生年月日 \nDate of birth",null,null,"性別 \nSex",null,"続柄　\nRelationship"]
[]
[]
[]
["８．滞在費の負担者または機関\nPerson or office responsible for your living expense",null,"名前Name :"]
[null,null,"Tel and Email :"]
["９. 連絡先","日本の住所（日本滞在中の者）\nAddress in Japan"]
[null,"日本の携帯電話番号\nMobile phone number in Japan"]
[null,"日本で使用するメールアドレス\nEmail address in Japan"]
[null,"出身国での住所または連絡先\nAddress in home country"]
[null,"出身国の国コードを含む電話番号\nPhone number including country code"]
[null,"出身国で使用するメールアドレス\nEmail address used in your country"]
["（添付書類）"]
["①学生証または入学許可証明書の写し　②在留カードの写し　③結婚を証明できる書類（家族室・夫婦室を希望する場合のみ）"]
["① a copy of “Student ID” or “Certificate of entrance admission”　②copies of “Resident Card” of all family members."]
[" ( If you don't have any of card yet, please submit the copy as soon as you obtain it.)③a copy of marital status. (Ex; Jyu-min hyo, marriage certificate, etc)"]
[]
["＊入居申請書の記載及び提出書類の情報は、入居者選考以外の目的には利用されません。"]
["The personal information provided above will be used only for selection processes and will not be disclosed to any other parties."]
[]
["〈申請者控〉 〈Receipt〉"]
["       あなたの受付番号は",null,"  　　　　　　　　　","-",null,"　　　番です。   ",null,null,"結果が分かるまでこの半券は保管して下さい。"]
["　　　Your registration number is",null,null,null,null,null,null,null,"Please keep this stub until you know the result."]
["結果通知は、受付番号で留学生課前に掲示板、及び大学HPへ掲載します。"]
["The result will be announced by the registration number. Please check the board in front of ISD and/or the website at Chiba University ."]
["学務部留学生課 　Tel: 043-290-2195、cu-dormitory@chiba-u.jp"]