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["申請番号","2024XXXXXXXXXX",null,null,null,null,"※ポータルサイト内の申請状況照会画面の\n申請番号を入力してください",null,null,null,null,null,null,"提出日",null,"20XX",null,"年","X","月","X","日"]
["学外実習における宿泊費補助報告書"]
[]
["※事前申請した実習ごとに報告書の提出が必要です"]
["※色塗り箇所を記入してください"]
["所属※プルダウン選択","診療放射線学科",null,null,null,null,null,null,null,null,"学生番号(6桁)",null,null,null,null,"2XX - 0XX"]
["フリガナ","ヒロコク　タロウ",null,null,null,null,null,null,"連絡先\n※日中連絡が取れる番号\nを記入すること",null,null,null,null,"0XX-XXXX-XXXX"]
["氏　　名","広国　太郎"]
["現住所","広島県○○市○○町○○番地○　○○アパート○○号室"]
["帰省先住所","岡山県○○市○○町○○-○　○○マンション　○○号室"]
["振込先","ゆうちょ",null,null,null,"銀行",null,"五一八",null,null,null,"支店",null,"フリガナ",null,null,"ヒロコク　タロウ"]
[null,"口座種別",null,null,null,null,"（普通）",null,null,null,null,null,null,"口座名義",null,null,"広国　太郎"]
[null,"口座番号（7桁）\n※プルダウンから数字を選択",null,null,null,null,0,4,0,5,6,0,0,null,"本人口座",null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他口座",null,null,"（続柄：",null,null,null,"）",null,null,null,1]
["実習科目名","臨床実習（Ⅰ期）",null,null,null,null,null,null,null,null,null,null,null,"実習先集合時間",null,null,null,"08:00:00",null,null,null,null,null,null,null,2]
["実習施設名","○○法人　△△病院",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3]
["実習施設住所","広島県○○市○○町○○番地○",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,3]
["実習日\n※カレンダー形式で\n数字を記入\n※実習がなかった日は\n記載しないこと\n※学内実習日は除くこと","20XX",null,null,"年","X",null,"月","20XX",null,null,"年","X",null,"月","20XX",null,null,"年","X",null,"月",null,null,null,6]
[null,"日","月","火","水","木","金","土","日","月","火","水","木","金","土","日","月","火","水","木","金","土",null,null,null,7]
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[]
[]
["宿泊補助対象日",null,null,null,"計",15,null,"日",null,null,null,"計",10,null,"日",null,null,null,"計",null,null,"日"]
[null,"↑宿泊補助対象日：実習前日～実習最終日前日までの日数を計算して記入　※実習が無い日の前日は補助対象外"]
["宿泊補助対象日\n合計日数",25,null,null,null,null,"泊（宿泊補助対象日の合計日数を記入）"]
["宿泊費合計\n（領収書の総額）",165000,null,null,null,null,"円"]
["補助金額の\n算出について","（領収書金額）÷（宿泊日数）＝（宿泊単価）※少数点以下は切り捨て\n【（宿泊単価) － (自己負担額1,000円）】×（補助対象合計日数）= 補助金額\n　※【（宿泊単価）－（自己負担額1,000円）の上限は4,000円】",null,null,null,null,null,null,null,null,null,null,null,null,null,"※領収書の合計金額から宿泊費単価を算出し\n自己負担分として1,000円差し引いた金額\nが補助されます\n※対象外料金が含まれる場合は、対象外料金を差し引いた金額になります。"]
[]
["※※報告書を提出する前に必ず下記項目について確認し、チェックを入れること！※※"]
["　　　領収書の名義は申請者本人または保護者の名義になっており、宿泊期間・素泊まりの料金が記載されているものですか"]
["　　　裏面に領収書は貼付していますか"]
["　　　申請番号は記入していますか"]
["　　　振込先口座がゆうちょ銀行の場合、支店名・口座番号に間違いないですか。"]
["　　　※ゆうちょ銀行のキャッシュカードには支店名・口座番号は記載されていません。"]
["　　　　キャッシュカードしか無い場合は、必ず下記URLから支店名・口座番号を調べて記入すること"]
["　　　　ゆうちょ銀行　支店名・口座番号検索サイトURL\n　　　　　【https://www.jp-bank.japanpost.jp/kojin/sokin/furikomi/kouza/kj_sk_fm_kz_1.html】"]
[]
["　　　記載漏れはないですか"]
[]
[]
["【教務係記入欄】"]
["宿泊施設利用補助金額［（宿泊単価/1日－1,000円）×泊数］"]
["宿泊単価（税込）","自己負担額1,000円",null,null,null,"泊数",null,null,"補助金額",null,null,null,null,null,null,null,null,"受付印"]
[null,"△1,000円"]
[null,null,null,null,null,null,null,null,null,null,null,null,"課長",null,null,"係長",null,null,"係"]

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["申請番号",null,null,null,null,null,"※ポータルサイト内の申請状況照会画面の\n申請番号を記入してください",null,null,null,null,null,null,"提出日",null,null,null,"年",null,"月",null,"日"]
["学外実習における宿泊費補助報告書"]
[]
["※事前申請した実習ごとに報告書の提出が必要です"]
["※色塗り箇所を記入してください"]
["所属※プルダウン選択",null,null,null,null,null,null,null,null,null,"学生番号(6桁)"]
["フリガナ",null,null,null,null,null,null,null,"連絡先\n※日中連絡が取れる番号\nを記入すること"]
["氏　　名"]
["現住所"]
["帰省先住所"]
["振込先",null,null,null,null,"銀行",null,null,null,null,null,"支店",null,"フリガナ"]
[null,"口座種別",null,null,null,null,"（普通）",null,null,null,null,null,null,"口座名義"]
[]
[null,"口座番号（7桁）\n※プルダウンから数字を選択",null,null,null,null,null,null,null,null,null,null,null,null,"本人口座"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"その他口座",null,null,"（続柄：",null,null,null,"）"]
["実習科目名",null,null,null,null,null,null,null,null,null,null,null,null,"実習先集合時間"]
["実習施設名"]
["実習施設住所"]
["実習日\n※カレンダー形式で\n数字を記入\n※実習がなかった日は\n記載しないこと\n※学内実習日は除くこと",null,null,null,"年",null,null,"月",null,null,null,"年",null,null,"月",null,null,null,"年",null,null,"月"]
[null,"日","月","火","水","木","金","土","日","月","火","水","木","金","土","日","月","火","水","木","金","土"]
[]
[]
[]
[]
[]
["宿泊補助対象日",null,null,null,"計",null,null,"日",null,null,null,"計",null,null,"日",null,null,null,"計",null,null,"日"]
[null,"↑宿泊補助対象日：実習前日～実習最終日前日までの日数を計算して記入　※実習が無い日の前日は補助対象外"]
["宿泊補助対象日\n合計日数",null,null,null,null,null,"泊（宿泊補助対象日の合計日数を記入）"]
["宿泊費合計\n（領収書の総額）",null,null,null,null,null,"円"]
["補助金額の\n算出について","（領収書金額）÷（宿泊日数）＝（宿泊単価）※少数点以下は切り捨て\n【（宿泊単価) － (自己負担額1,000円）】×（補助対象合計日数）= 補助金額\n　※【（宿泊単価）－（自己負担額1,000円）の上限は4,000円】",null,null,null,null,null,null,null,null,null,null,null,null,null,"※領収書の合計金額から宿泊費単価を算出し\n自己負担分として1,000円差し引いた金額\nが補助されます\n※対象外料金が含まれる場合は、対象外料金を差し引いた金額になります。"]
[]
["※※報告書を提出する前に必ず下記項目について確認し、チェックを入れること！※※"]
["　　　領収書の名義は申請者本人または保護者の名義になっており、宿泊期間・素泊まりの料金が記載されているものですか"]
["　　　裏面に領収書は貼付していますか"]
["　　　申請番号は記入していますか"]
["　　　振込先口座がゆうちょ銀行の場合、支店名・口座番号に間違いないですか。"]
["　　　※ゆうちょ銀行のキャッシュカードには支店名・口座番号は記載されていません。"]
["　　　　キャッシュカードしか無い場合は、必ず下記URLから支店名・口座番号を調べて記入すること"]
["　　　　ゆうちょ銀行　支店名・口座番号検索サイトURL"]
["　　　　【https://www.jp-bank.japanpost.jp/kojin/sokin/furikomi/kouza/kj_sk_fm_kz_1.html】"]
["　　　記載漏れはないですか"]
["【教務係記入欄】"]
["宿泊施設利用補助金額［（宿泊単価/1日－1,000円）×泊数］"]
["宿泊単価（税込）","自己負担額1,000円",null,null,null,"泊数",null,null,"補助金額",null,null,null,null,null,null,null,null,"受付印"]
[null,"△1,000円"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"課長",null,null,"係長",null,null,"係"]

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["学科（プルダウン）"]
["診療放射線学科",0]
["医療技術学科　臨床工学専攻",1]
["医療技術学科　臨床検査学専攻",2]
["救急救命学科　",3]
["リハビリテーション学科　理学療法学専攻",4]
["リハビリテーション学科　作業療法学専攻",5]
["リハビリテーション学科　言語聴覚療法学専攻",6]
["リハビリテーション学科　義肢装具学専攻",7]
["心理学科",8]
["医療経営学科",9]
["医療福祉学科　医療福祉学専攻"]
["医療福祉学科　介護福祉学専攻"]
["医療福祉学科　保育福祉学専攻"]
["健康スポーツ学科"]
["社会学科　社会福祉学専攻"]
[]
[""]