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[" 令和７年度入試用"]
["受験番号",null,null,"ふりがな",{"$nulls":10},"性  別",null,null,"調　査　書"]
["※",null,null,"氏名",{"$nulls":10},"男・女"]
["学籍の記録",null,"　本年度卒業見込み",{"$nulls":7},"特記事項"]
["教科学習の記録","      　　　","必修教科の評定",{"$nulls":15},"選択教科の評定"]
[]
[]
[null,"第１学年"]
[null,"第２学年"]
[null,"第３学年"]
[null,"全学年の計"]
[null,"備　　考"]
[]
["時間の記録　　総合的な学習","第１学年"]
[null,"第２学年"]
[null,"第３学年"]
["出欠の記録","学　　年","欠席日数",null,null,"欠 席 の 主 な 理 由 等"]
[null,"第１学年"]
[null,"第２学年"]
[null,"第３学年"]
[null,"合　　計"]
["行動の記録",null,"基本的な生活習慣",{"$nulls":5},"健康・体力の向上",{"$nulls":6},"自主・自律",null,null,null,"責  任  感",{"$nulls":4},"創  意  工  夫"]
["（第３学年）",null,"思いやり・協力",{"$nulls":5},"生命尊重･自然愛護",{"$nulls":6},"勤労・奉仕",null,null,null,"公正・公平",{"$nulls":4},"公共心・公徳心"]
["特別活動の記録","学級活動"]
[null,"生徒会          活動"]
[null,"学校行事"]
["部活動等の記録","部 活 動"]
[null,"そ の 他"]
["総合所見"]
[]
[]
[]
["本書の記載事項に誤りがないことを証明します。",{"$nulls":15},"中学校名"]
[]
["令和　　　　年　　　月　　　日",{"$nulls":15},"中学校長"]
[]
[{"$nulls":16},"記載責任者　教諭"]
[]
["※受験番号は本校で記載いたします。"]
["中央学院高等学校"]