豊橋技術科学大学



Examinee's No.

Application Form for Admission in International Doctoral Degree Program

Graduate School of Engineering, Toyohashi University of Technology

for the Academic Year 2020 (Entrance in October 2020)

|1. Personal details |

|Name in Full | |Paste your photograph or|

| | |digital image taken |

| | |within the past 3 |

| | |months. (30mm×40mm) |

| |(Please write your name exactly as it appears on your passport) | |

|Chinese character,| | |

| | | |

|if any | | |

|Sex |□Male |□Female | |

|Marital status |□Single |□Married | |

|Date of birth | |Nationality | |

|(yyyy/mm/dd) | | | |

|Current resident |Zip code(〒): |

|address | |

| | |

|E-mail address | |Phone number | |

| | |(with country code) | |

|Immigration visa |(For those who are already living in Japan) |Visa valid until | |

|status | |(yyyy/mm/dd) | |

| | | | |

|Your status in |□Japanese Government Scholarship Student* □JICA student □Self-financed student |

|October 2020 |*Certificate of Japanese Government Scholarship should be attached. |

|2. Academic preference |

|Preferred Department |□ Mechanical Engineering |

|(Choose one of five |□ Electrical and Electronic Information Engineering |

|courses) |□ Computer Science and Engineering |

| |□ Applied Chemistry and Life Science |

| |□ Architecture and Civil Engineering |

|Supervisor at TUT | |

| |(You must obtain his/her approval and have enough discussion on your research plan beforehand) |

|3.English Proficiency |

|Is English your first language? |

|□ Yes □ No □ No, but I have completed English-based degree program* |

|*English-based degree program means all lectures, examinations, reports and thesis and any other instructions given to students during your |

|degree program are provided in English only. |

|If No, what is your first language? ( ) |

|English language proficiency test (TOEFL, IELTS etc) |Overall score |Date taken (yyyy/mm/dd) |

| | | |

(This application form is required both-sided print)

|4. Educational background |

| |Name of institution/ |From |To |Year(s) of |Diploma or Degree awarded,|

| |Location(City, Country) | | |study |Skipped years/levels* |

| | |yyyy/mm |yyyy/mm | | |

|Elementary Education | | | | | |

|Secondary Education | | | | | |

|(Junior High School) | | | | | |

|Upper Secondary School | | | | | |

|(High School) | | | | | |

|Higher Education | | | | | |

|(University, | | | | | |

|Undergraduate Level) | | | | | |

|Graduate Level | | | | | |

|Total years of schooling（学校教育修学年数） | |years |

|Notes |

|1) Preparatory education for university admission is included in secondary education. |

|2) Any school years or levels skipped should be indicated in the column of Diploma or Degree Awarded, Skipped years/Levels (Example: |

|Graduated high school in 2 years), and an official document from the institution which applicants graduated attesting to this should be |

|attached. |

|3) If you attended multiple schools at the same level of education due to moving house or readmission to university, then write the schools |

|in the same column and include the number of years of study and current status for each school. |

|4) Calculate and write the total number of years studied based on duration as a student (including extended leave such as summer vacation) |

|5. Work experience（if any） |

|From / To |Name of institution/company |Position / Job title |Type of work |

|(yyyy/mm－yyyy/mm) | | | |

| | | | |

| | | | |

| | | | |

|6. Declaration |

| I confirm that the information I have given in this form is true, complete and accurate and no information requested or other material |

|information has been omitted. I have read the notes of application procedure, in particular those relating to this section. I understand |

|what they say and I agree to abide by the conditions set out there. I acknowledge that the information on this form will be used in |

|accordance with Japanese data protection rules and will be used to form the basis of my student record. I give my consent to the processing |

|of my data by the university. I accept that, if I do not fully comply with these requirements the university shall have right to cancel my |

|application and I shall have no claim against the university in relation thereto. |

|Full name in block| |Date: |

|capital and | | |

|signature | | |

| | | |

| |Signature | |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download