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["（様式第１－１号）"]
["Form 1-1"]
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[null,"入居申請書（留学生） / APPLICATION FOR RESIDENCE（Student)"]
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["埼玉大学国際交流会館長　殿"]
["To: House Director of Saitama University International House"]
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[null,"下記のとおり、埼玉大学国際交流会館に入居したいので申請いたします。\nI hereby apply for residence in the Saitama University International House. \n\n"]
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[null,"記"]
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[null,"申請者 / Applicant"]
[null,"*申請日\n*Application Date","*所属部局\n*Faculty or Graduate School","*受入教員氏名\n*Name of Supervisor","*入居希望区分\n（第一希望）\n*Type of Room Desired\n(First Choice)","入居希望区分\n（第二希望）\nType of Room Desired\n(Second Choice)","*入居希望日\n*Date of Moving-in","*退去希望日\n*Date of Moving-out","*学費区分\n*Japanese Government Scholarship Student or Privately Financed  Student","学籍番号\nStudent Number"]
[null,null,null,null,null,null,"April 1st,2019"]
[]
[null,"*氏名（英字)\n*Name in Alphabet","氏名（カナ）\nName in KATAKANA","氏名（漢字）\nName in KANJI","*生年月日\n*Date of Birth\n(YYYY/MM/DD)","*性別\n*Sex","*国籍\n*Nationality","*身分\n*Status","電話番号\nTelephone Number","*メールアドレス\n*Email Address"]
[null,null,null,null,null,null,null,"留学生"]
[]
[null,"同居家族 / Accompanying Family Members"]
[null,"氏名（英字)\nName in Alphabet","氏名（カナ）\nName in KATAKANA","氏名（漢字）\nName in KANJI","生年月日\nDate of Birth\n(YYYY/MM/DD)","性別\nSex","国籍\nNationality","続柄\nRelationship to Applicant"]
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[null,"その他 / Others",null,null,"備考 / Notes"]
[null,"*寄宿料の支払い\n*Method of Financial Support to Pay Rent",null,null,"*マークは必須\nPlease note that all fields followed by an asterisk must be filled in."]
[null,"自己負担 / Self Financed",null,null,null,null,null,null,null,"2頁へ続く"]
[null,null,null,null,null,null,null,null,null,"continued on page 2"]
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[null,"誓約事項 / Pledge"]
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[null,"　私は、埼玉大学国際交流会館に入居した際は、次の事項を守ることを制約します。\n　万一履行しない場合は、入居許可期間中に退去処分を受けても不服は申しません。また、退去処分に伴って生じた損害の賠償の請求はいたしません。\n\n（１）定められた使用料又は寄宿料、光熱水料その他必要な経費は、指定の期日までに完納すること。\n（２）会館の施設、備品等を損傷又は滅失したときは損害を賠償すること。\n（３）他の入居者に騒音、振動、悪臭等による迷惑をかけないこと。\n（４）退去時に居室を入居時の状態に復旧するための清掃費、補修費等の経費及び未払いの光熱水料その他必要な経費の精算を円滑に行うための金額を、\n　　入居後に館長の指示によりあらかじめ積立てること。\n（５）来訪者を居室に宿泊させないこと。ただし、特別の事情のある場合は除く。\n（６）その他会館に関する諸規則及び指示された事項を守ること。"]
[null,"I hereby affirm that I will observe the following terms during my residence in the Saitama University International House.\nI will not submit any complaint in the event that my admission is cancelled due to noncompliance with these terms. Furthermore, I will not claim compensation for any losses that may be incurred on account of the cancellation.\n\n(1) I will pay all rent, utility fees, and other expenses, before the specified dates.\n(2) I will pay for any damages to the facilities or equipment of the residence for which I am responsible.\n(3) I will not cause any trouble to other residents by making unreasonable noise or producing offensive odours.\n(4) I understand that the House Director may retain part or all of my security deposit after my departure, as payment for cleaning and restoration costs.\n(5) I will not allow overnight visitors in my room without special permission from the House Director.\n(6) I will observe all regulations, rules and other instructions as specified by the International House."]
[]
[null,"プルダウンリスト"]
[null,"所属部局","Faculty of Liberal Arts","Faculty of Economics","Faculty of Education","Faculty of Science","Faculty of Engineering","Grad. Sch. of Humanities and Social Sciences","Grad. Sch. of Education","Grad. Sch. of Science and Engineering","Saitama University"]
[null,"入居希望区分","単身室 / Single Room","夫婦室 / Couple Room","家族室 / Family Room"]
[null,"退去希望日","August 23rd, 2019","March 6th, 2020"]
[null,"学費区分","国費 / Japanese Government Scholarship Student","私費 / Privately Financed Student"]
[null,"性別","男 / Male","女 / Female"]
[null,"続柄","配偶者 / Spouse","子 / Child"]
[null,"支払い","自己負担 / Self Financed","受入教員の研究費 / Fund of Supervisor"]

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[null,null,null,"様式　A"]
[null,null,null,"Form A"]
["入居申請者調書"]
["Application for I-House"]
[]
["*氏 名\n*Name"]
["*入学年月日\n*Date of Admission"]
["学籍番号\nStudent ID Number"]
["*独身・既婚の別\n*Marital status",null,null,null,null,"独身 / Single","既婚 / Married"]
["*現住所\n*Address"]
["*寝具レンタル希望の有無\n*Whether you want to rent a set of bedclothes or not",null,null,null,null,"希望する / Yes","希望しない / No"]
["*入居希望理由\n*Reason you want to live in I-House"]
["以前に国際交流会館に住んでいたことがある場合、その入居期間\nIn case you have lived in I-House in past, the period of the residence"]
[]
["*収入 / *Income"]
["母国からの仕送り\nMoney sent by family",null,null,"円/月\nYen/Month"]
["奨学金\nScholarship allowance","名称\nName"]
[null,"金額\nAmount",null,"円/月\nYen/Month"]
[null,"期間\nPeriod","From                                to"]
["アルバイト\nPart-time job",null,null,"円/月\nYen/Month"]
["同居家族の収入\nIncome of spouse",null,null,"円/月\nYen/Month"]
["その他の収入\nOthers",null,null,"円/月\nYen/Month"]
[]
["*マークは必須"]
["Please note that all fields followed by an asterisk must be filled in."]

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[null,null,null,null,null,null,null,null,null,null,null,null,null,"様式　B"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"Form B"]
["居 室 変 更 申 請 書"]
[null,"APPLICATION FOR ROOM CHANGE"]
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["埼玉大学国際交流会館長　殿",null,null,null,null,null,null,null,null,null,"　　　　　　","年","月","日"]
["To: House Director,",null,null,null,null,null,null,null,null,null,"Date：","Year","Month ","Day"]
["     Saitama University International House"]
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[null,null,null,null,null,null,"居室番号 Room Number ："]
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[null,null,null,null,null,null,"フリガナ"]
[null,null,null,null,null,null,"氏　名（漢字）"]
[null,null,null,null,null,null,"Name(in block letters)："]
[null,null,null,null,null,null,null,null,null,"Last",null,"First ",null,"Middle"]
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[null,null,null,null,null,null,"署名　Signature："]
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[null,null,null,null,null,null,"所属学部・研究科　Faculty or Graduate school："]
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[null,null,null,null,null,null,"学籍番号　Student ID Number"]
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["下記理由により、居室変更したいので申請いたします。"]
["I hereby apply for room change."]
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["記"]
[1,"入居を許可されている期間"]
[null,"Permitted period of residence"]
[]
[null,null,null,null,"年","月","日","～",null,"年","月","日"]
[null,null,null,"from","Year","Month","Day",null,"to","Year","Month","Day"]
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[2,"居室変更区分"]
[null,"Type of room desired： "]
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[null,"□単身室 Single room → 夫婦室 Couple room",null,null,null,null,null,null,"□単身室 Single room → 家族室 Family room"]
[]
[null,"□夫婦室 Couple room → 単身室 Single room",null,null,null,null,null,null,"□夫婦室 Couple room → 家族室 Family room"]
[]
[null,"□家族室 Family room → 単身室 Single room",null,null,null,null,null,null,"□家族室 Family room → 夫婦室 Couple room"]
[]
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[3,"変更を必要とする理由"]
[null,"Reason (those living with their family must complete the form on the back page.)"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,"２頁へ続く"]
[null,null,null,null,null,null,null,null,null,null,null,null,null," to be continued to page 2"]
[]
[]
[4,"同居家族"]
[null,"Accompanied family members"]
[null,"氏　　名",null,null,null,"生年月日",null,null,"性　　別",null,"続　　　柄"]
[null,"Name",null,null,null,"Date of birth",null,null,"Sex",null,"Relationship to applicant"]
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["備考"]
[null,"１．この申請書を提出しても、必ず許可されるとは限らない。"]
[null,"    Please note that applications will not always be approved."]