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[{"$nulls":10},"記入日",null,null,null,"年",null,"月",null,"日"]
[{"$nulls":10},"DATE",null,null,null,"/",null,"/"]
[]
["帰国報告書"]
["Notification of Return"]
[]
["学生部長　様"]
["To The Dean of Student Affairs "]
[{"$nulls":8},"学籍番号 Student Number　　　　　　　　　　　　　　　 "]
[{"$nulls":8},"学部・研究科 School/Graduate School　　　　　　　　　　　  "]
["　 ",{"$nulls":7},"学科・専攻 Department/Division　                  　"]
[{"$nulls":8},"学    年 Year of Study Program",{"$nulls":9},"年"]
[{"$nulls":8},"氏　  名 Name  　　　　　　　　　　 　　　　　   　 "]
[{"$nulls":8},"電話番号 Phone Number ",{"$nulls":5},"－",null,"－"]
[]
["下記のとおり、帰国しましたので報告いたします。"]
["I hereby inform you of my upcoming return from overseas (including my home country), as follows."]
["記"]
[" 渡航先国名\nCountries of Destination",{"$nulls":8},"渡航先都市名 \nCities of Destination"]
["渡航期間 \n Length of Stay",null,null,null,"(日本出発日)",{"$nulls":6},"(日本帰国日)"]
[{"$nulls":6},"年",null,"月",null,"日～",null,null,null,"年",null,"月",null,"日"]
[{"$nulls":5},"Departure Date from Japan",{"$nulls":7},"Return Date to Japan"]
["渡航理由\nPurpose of Your Travel"]
["帰国後の健康状態 \n\nYour Health Condition \nAfter Return to Japan",null,null,null,"・発熱はありますか？",{"$nulls":9},"□","はい","□","いいえ"]
[{"$nulls":4},"  　Do you have a fever? ",{"$nulls":10},"Yes",null,"No"]
[{"$nulls":4},"・下痢をしていますか？",{"$nulls":9},"□","はい","□","いいえ"]
[{"$nulls":4},"  　Do you have diarrhea? ",{"$nulls":10},"Yes",null,"No"]
[{"$nulls":4},"・その他自覚症状はありますか？",{"$nulls":9},"□","はい","□","いいえ"]
[{"$nulls":4},"　　Do you have any other symptoms? ",{"$nulls":10},"Yes",null,"No"]
[]
[]
[]
[{"$nulls":4},"・上記の場合、医療機関で治療を受けましたか？",{"$nulls":9},"□","はい","□","いいえ"]
[{"$nulls":4},"　　Did you have a medical check after had the symptoms?  ",{"$nulls":10},"Yes",null,"No"]
[]
["＊注意事項(Attention)"]
[null,"・ 帰国後1週間以内に学生室へ提出してください。"]
[null,"　　Please submit a “Notification of Return” form to the Student Affairs Office within a week of returning."]
[null,"・ 健康状況に不安がある場合は、医務室へ相談してください。"]
[null,"　　If you have a health problem, please go to the medical room. "]
[]
["〔提出先〕"]
[null,null,"静岡県立大学学生部学生室　University of Shizuoka, Student Affairs Office　"]
[null,null,"TEL：+81-54-264-5009   E-mail：kaigaitokou@u-shizuoka-ken.ac.jp"]