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["（様式第１－３号）"]
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[null,"入居申請書（日本人学生） "]
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["埼玉大学国際交流会館長　殿"]
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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。\n\n\n"]
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[null,"記"]
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[null,"申請者 "]
[null,"*申請日\n","*所属部局\n","*指導教員氏名\n","*入居希望区分\n（第一希望）\n","入居希望区分\n（第二希望）\n","*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","学籍番号\nStudent Number"]
[null,null,null,null,"単身室",null,null,null,"私費"]
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[null,"*氏名（英字)\n","氏名（カナ）\n","氏名（漢字）\n","*生年月日\n","*性別\n","*国籍\n","*身分\n","電話番号\n","*メールアドレス\n"]
[null,null,null,null,null,null,null,"日本人学生"]
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[null,"事務確認欄（申請者は記入不要）"]
[null,"氏名（英字)\n","氏名（カナ）\n","氏名（漢字）\n","生年月日\n\n(YYYY/MM/DD)","性別\n","国籍\n","確認\n"]
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[null,"その他 / Others",null,null,"備考 "]
[null,null,null,null,"*マークは必須（ただし、指導教員がいない場合は「なし」と記入のこと）\n",null,null,null,null,null,"*"]
[null,"自己負担 / Self Financed",null,null,null,null,null,null,null,"2頁へ続く"]
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[null,"誓約事項 "]
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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。"]
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[null,"プルダウンリスト"]
[null,"所属部局","教養学部","経済学部","教育学部","理学部","工学部","人文社会科学研究科M","人文社会科学研究科D","理工学研究科M","理工学研究科D"]
[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","March 3rd, 2023","March 4th, 2024"]
[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"]