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Web問診 健康診断受検証明書 発行申請
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Email
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Your email
お名前 - Name -
*
Your answer
フリガナ - Kana Name -
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Your answer
学生番号（10桁）- Student ID(10 digits) -
*
Your answer
所属 - Faculty -
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Your answer
生年月日
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MM
/
DD
/
YYYY
連絡先電話番号 - Phone number -
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Your answer
用途 - purpose -
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Your answer
受取方法 - How to receive -
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申込日の３日後以降で指定 - Specify 3 or more days after the application date -
健康管理室来所 - Receive at the Health Care Office -
健康管理室 宇治分室来所
健康管理室 桂分室来所
郵送 - Receive by post -
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