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["国際教養大学教職員の派遣等申込書"]
[null,null,null,null,null,null,null,null,null,null,null,null,"申込年月日：",null,null,null,null,"年",null,"月",null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"《申込書のご提出は、事業実施日の1ヶ月前までにお願いします》"]
[]
["次のとおり国際教養大学教職員の派遣等を申し込みます。"]
["※ご記入いただいた情報は、本事業及び本学での統計処理の目的以外には使用しません。"]
[]
["項目",null,null,null,"内　　　容"]
["種別",null,null,null,"<対象：高校生>",null,null,null,null,null,"出前講座",null,null,"模擬授業",null,null,"その他（　　　　　　　）"]
[null,null,null,null,"<対象：高校生以外>",null,null,null,null,null,"講師派遣等",null,null,null,"その他（　　　　　　　）"]
["教職員名"]
["専門分野等"]
[]
[null,null,null,null,"※ご希望の教職員が決まっていない場合は、希望する専門分野等をご記入ください"]
["事業名"]
[]
["事業内容\n※参考資料があれば\n添付してください。"]
[]
[]
[]
["対象者",null,null,null,null,null,"高校生",null,null,null,"大学生",null,null,null,"一般",null,null,"その他（　　　　　）"]
["対象者数",null,null,null,null,null,null,null,null,null,null,null,null,null,"人"]
["希望日時",null,null,null,"第１希望",null,null,null,null,"年",null,"月",null,"日",null,null,"：",null,"～",null,"："]
[null,null,null,null,"第２希望",null,null,null,null,"年",null,"月",null,"日",null,null,"：",null,"～",null,"："]
["場所／施設"]
["使用言語",null,null,null,null,"日本語",null,null,"英語",null,null,"中国語",null,null,"韓国語",null,null,"その他（　　　　　）"]
["通訳(主催者用意)",null,null,null,null,"無し",null,"・",null,"有り（",null,null,"同時通訳",null,null,"逐次通訳",null,null,"その他　）"]
["交通手段",null,null,null,null,null,null,"主催者送迎",null,null,null,null,"旅費支給"]
["謝金等",null,null,null,null,null,null,"無し",null,null,null,null,"有り","（金額",null,null,null,null,"円","）"]
["団体名"]
["代表者職氏名",null,null,null,"職名：",null,null,null,null,null,null,null,null,"氏名："]
["担当者職氏名",null,null,null,"職名：",null,null,null,null,null,null,null,null,"氏名："]
[null,"住所",null,null,"〒"]
[null,"連絡先",null,null,"TEL：",null,null,null,null,null,null,null,null,"FAX："]
[null,"Ｅメール",null,null,null,null,null,null,null,null,null,null,null,null,"＠"]
["※申込先　【FAX】018-886-5910　【電話】018-886-5904 / 5905 【Eﾒｰﾙ】cos@aiu.ac.jp　\n　　　　　【郵送】〒010-1292秋田市雄和椿川字奥椿岱　国際教養大学 研究・地域連携支援課"]