ࡱ> FIEU R-bjbjnn<0aa   8T)"XXXXX!!!!!!!$#&F!-!XXT!lXX!!XVL:|!!0)"&'&'$>,$:!!8)"' R b: N Bf Q V J\ Application for Temporal Absence from Japan t^000g000e year month day 0000000000000000000J\Qr T 0000000000000000000Signature00000000000000000 Nn0h0J00NBfQVW0~0Y00 I will leave Japan temporarily as follows. f[M|juS Student ID numberl T Name (print)VM| NationalityQVHQn0V T DestinationQVHQn0#a}HQ Contact Address & Phone Number TELg Period of Absence000t^000g000e^000t^000g000e year month day year month dayvv Purposes 0 Nn0h0J00NBfQVJ\0xW0~0W0_00 I accepted the application submitted by the person above, a student under my supervision. 000000000000000000c\YeT0000000000000000pS Advisor s Name (print) l Qzvn010eMR~0g0k0@b^\f[0xvzyn0Yuf[ubS_Ok0cQW0f0O0`0U0D00 00wmY>mc/ec0000k0NBfQVn0`1X0{v2W0f0O0`0U0D00 QVgL01K0gN Nn04XTo00e,gk0;bc0f0K000^V_1K0g0vk0 0eP^rl3uJTf 00wmY>mc/ec0000k0000000W0f0 NU0D00 Note: 1. Submit this form to the International Student Office at your faculty 10 days at least before departure. 2. Register the information of your tempora  jln  l    & ( 6 J P ^ n ȿȺȟȇȂ}y}y}toooo ho( h@,o(h ho( h.(o( htIo(hhnHo(tH h>*o(hh>*o(hnHo(tHhDho( hDo(hDnHo(tH ho( hJo(h.(hw5kCJ aJ nHo(tHh.(CJ aJ nHo(tHh.(hCJ aJ nHo(tH+ln F   ( L N $If WDd`gd^rtgd $,4$],a$gdD$a$gd$a$gdD$a$gd.(N P V p r xrrr$Ifkd$$Ifc0$ ! n t0644 lapytrr t z xrrr$Ifkd$$Ifc0$ ! n t0644 lapytr xrrr$Ifkd4$$Ifc0$ ! n t0644 lapytr     xrrrrrr$Ifkd$$Ifc0$ ! n t0644 lapytr      . D z " & . > @  0 p r x >@ςϰ}yto h6.o( ho(h  ho(h@,hrhA5nHo(tHhrh1 h5nHo(tHhrh >*nHo(tHh nHo(tHhKhb!@o( h Po(hK hKo( h@,o( h.(o( hmo( h o( h(o( ho(hh(o( ho( hJo()  " F z xrrrr$Ifkdh$$Ifc0$ ! n t0644 lapytr xrrr$Ifkd$$Ifc0$ ! n t0644 lapytr & 0 xvppppp$Ifkd$$Ifc0$ ! n t0644 lapytr <())}xiiZxLWD^`Lgd=LWD^`Lgd^rtgd!JVDWD8^`gdnkd6$$Ifc!! t0644 lap ytr @Ht(((((())<)T))))*b-d-f-h-l-n-r-t-x-z---޽ͽͽh}"jh}"U h=o(h1'h^rto(h1'h(o( h1'o(h=h(o(h= ho( hYQo(UhlqhYQh( h@,o( hAo( h!Jo( h(o(hz~hz~o( ho( hz~o(+ry leaving in YUGO (Student support system for YU students going overseas). 3. If you stay abroad over one month, you must upload the Health Declaration Form to YUGO the one month after returning to Japan. PN`1Xk0d0D0f0 0S0n03uˊfk0eQU00_0 PN`1Xo00YVNYuf[un0NBfQVk0d0D0f0bcY00_00k0O(uY000n0g0B000S00k00c0f0__0 PN`1X00rzL?elNI{n0O gY00 PN`1Xn0Owk0Y00l_,{agk0[U00f0D004XT0dM00J\Q,gNn0 Ta0_0S0h0j0O0Nn0vvg0O(uSo0,{ Nk0cOY00S0h0o0B00~0[000 The information that appears in this form will be used solely for those international students who are taking a leave of absence from the university to be elsewhere abroad. It will never be used for any other purpose or offered to a third party except on occasions stipulated in Article 9, Private Information Protection Law.     )*f-j-l-p-r-v-x-|-~---gd6. WD`gd1'gd!J :&P 12P:p. 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