Intensive Summer Course HIROSHIMA and PEACE 2013 Hiroshima City University

APPLICATION
CHOICE of LEVEL: UNDERGRADUATE / GRADUATE

Personal Information
Family Name: Date of Birth: Citizenship: Given Name: (dd/mm/yy) Middle Initial: Female / Male

Gender:

Native Language:

Mailing Address: Official letters and transcript will be sent to this address.

Phone:

Email:

Academic Information
Name of the Institution: Current Status Major/
Field of Study:

Reference

(1) undergraduate Entered in (year ) and student: currently 2nd year, 3rd year, 4th year, ( th) year or graduated in ( year ) and occupation: ( ) (2) graduate Masters level student Doctoral level student or student: Completed the Masters / Doctoral course in (year ) Occupation: ( )

Name of a Professor or Supervisor who could serve as a reference: Institution and Department:

Phone:

Email:

Statement of Purpose
In a separate file, write a brief self-introduction and essay on why you want to participate in the Intensive Summer Course. Please limit writing to one page.

Questions
Please complete and return by May 1, 2013 to Hiroshima-and-Peace@office.hiroshima-cu.ac.jp

Intensive Summer Course HIROSHIMA and PEACE 2013 Hiroshima City University
1. To non-Japanese students Would you like us to arrange a home stay accommodation? : 2. To All How did you find out about this course? : (

Yes

No

)

Please complete and return by May 1, 2013 to Hiroshima-and-Peace@office.hiroshima-cu.ac.jp

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