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Chuo University 1/8

Chuo University Student Exchange Program Check List of Application Materials Academic Year 2013/2014
Name of Student
Home Institution

Application Materials for Admission to Chuo University [ ] Application form with one identical photograph (43cm, recently taken, full face)* [ ] Statement of Purpose (Study/Research plan) *Please briefly indicate your study purpose and study/research plan. *This statement should be written clearly and precisely in order to select an appropriate academic adviser. *Write in English or Japanese. Applicants for Faculty of Law: Please try to fill in the application form in Japanese by hand. If you are not able to fill in Japanese, please contact International Center, Chuo University ( [ [ [ [ ] Certificate of Japanese Language Proficiency completed/signed by a Japanese language teacher* ] Certificate of Health ] Certificate of Enrollment ] Transcript of Academic Record

Applicants for Graduate Program ( ) Certificate(s) of Undergraduate Degrees ( ) Recommendation letter from an academic advisor Application Materials for Visa Document (Certificate of Eligibility) [ ] Application for Certificate of Eligibility with 2(two) same identical photographs (43cm, recently taken, full face) [ ] Declaration and Certification of Finances [ ] Verification of financial statement (a bank statement indicating saving balance, letter from scholarship foundation, etc.) [ ] Photocopy of valid passport

/Attention Please note that all documents should be written either in Japanese or English. Before you prepare the application materials, please read carefully the leaflet Chuo University student exchange program which is included important information on this program. Chuo University student exchange program

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Chuo University 2/8

Chuo University Student Exchange Program Application Form for Admission Academic Year 2012/2013
Personal Details *Please indicate the full legal name that will appear in your passport
Family Name: Given Names: (in full) Katakana() Kanji () if any Date of birth Y 19 /M /D SexM / F Nationality photo

Current addresses

Mailing address (for important documents)

Tel Fax E-mail

Tel Fax E-mail

Current Academic Status

Home Institution Program [ ] Undergraduate (Faculty) [ Major field Present year of Study ] Graduate school Master course Doctor course Name of Faculty/Department/Graduate School Minor field

Proposed period and level of study at Chuo University Period

[ ] 1 semester: [ ] 1 year: Program [ ] Undergraduate Senkasei (full-time non-degree student) [ ] Graduate ( ) Senkasei (full-time non-degree student) ( ) Kenkyusei (full-time non-degree research student) ( ) First semester (Apr2013Sep2013) ( ) Second semester (Sep2013Mar2014) ( ) First & Second semesters (Full acadmic year: Apr2013Mar2014) ( ) Second semester and first semester (Sep2012Aug2013)

Choice of Faculty and Department

Preferred Faculty/Graduate School Preferred Department Major Field (if any specific area)

*Please be sure to write the name of the Faculty/Graduate School/Department you would like to study at.

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Chuo University 3/8

List of Courses desired (for Senkasei only ) Courses

Please select five academic major courses that you would like to take from among the courses offered by the faculty/department of Chuo University to which you are applying. In selecting, please refer to CHUO UNIVERASITY COURSE CATALOG or go to followingweb page. Note: *Please do not include Japanese language courses or Japanese studies courses in this list. *The applicants for the Faculty of Commerce are required to select the subjects from among MAJOR SUBJECTS.

1. 2. 3. Credits

4. 5. *Please list course titles in order of preference.

Do you wish to obtain credits from Chuo University? [ ] Yes (Number of credits: How does your home institutions credit system work? [ ] classroom period(s) per week for weeks equals to

[ ] No min.)

credits. (*1 classroom period =

[ ] There is no credit system at my home institution. Personal Records List in chronological order all schools attended or entered since graduating junior high school. Name of Institution ex. Chuo High School Location (city/states) Tokyo From(mos./yrs.) Apr/2004 To (mos./yrs.) Mar/2007 Degree Diploma

*Total length of school education years (since you entered primary school) *Expected date of completion of the degree program at the home institution after you finish studying at Chuo University: year month Japanese Language Education Name of Institution Location(city/states) From(mos./yrs.) To(mos./yrs.)

Emergency Contact (parents preferable) Name Address Tel Mobile phone Relationship to you

Housing arrangement
[ ] [ ]

I request International Center to arrange and reserve my accommodation during my stay in Chuo Univ. I will be responsible for my own accommodation (I will find and reserve accommodation by myself).

******************************************************************************************************* APPLICATION CERTIFICATION I, the undersigned, certify that, to the best of my knowledge and belief, all of the information on and attached to this application is correct, complete and made in good faith. Date: Signature:

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Chuo University 4/8

(This academic reference form is necessary for applicants for graduate program only.)

Chuo University Student Exchange Program for International Students

Academic Reference
This form should be completed and signed by the Dean of the Graduate School of the applicant's home institution or equivalent person.)

To: President of Chuo University

Name of Student Home Institution

Name of Referee Signature Position Institution Date

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Chuo University 5/8

Chuo University Student Exchange Program

Certificate of Japanese Language Proficiency

This form should be completed and signed by a Japanese language teacher at the applicants home institution. If you have JLPT certificate, please submit JLPT certificate instead of this form.
Name of Student Home Institution Japanese Language Proficiency Excellent Good Fair Poor Listening Speaking Reading [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]


Reading and Writing of Kanji Number of recognizable Kanji Number of readable Kanji Number of writable Kanji

Number of Words Duration of Japanese Language Study hours/week hours months ( year month year month)

Total hours of study Teaching Method:



General Comments:

Name and Position of Japanese Language Teacher Name Signature Date: Position

Name of Japanese Language Institution

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Chuo University 6/8



*Please attach two same identical photographs (43cm, recently taken, full face). Name in full (Indicate the full legal name that will appear in your passport.) Roman letters Family Kanji, if any Family Nationality Sex[ ] male [ ] female Date of Birth Year Place of Birth Marital Status [ ] single [ ] married Current Address Passport (1) Number (2) Date of Issue Year (3) Date of Expiration Year (4) Issuing Authority Accompanying Persons, if any Place to Apply for Visa Past Entry into/Stay in Japan [ ]Yes The latest entry to Japan From year [ ]Yes (Details: month day time(s) [ ] No To year month day [ ] No Month Month Day Day Month Day First Middle First Middle

Criminal record(in Japan Overseas) ) [ ] No

Family in Japan (Father, Mother, Spouse, Son, Daughter, etc.) Please indicate Relationship, Name, Age, Nationality, Residence with Applicant or Not, Occupation, Status of Residence (Period of Stay).

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Chuo University 7/8

Registration at Chuo University () Doctor Master Undergraduate

Faculty/Course at Chuo University (Law) (Economics) (Politics) (Commercial) (Management) (Literature) (Psychology) (Education) Sociology (History) (Policy Studies)

(Science and Engineering) Others Name of Home Institution

Total period of education(from elementary school to last institution of education) years Date of graduation or expected graduation Year (Month) (Day)

Method of support to meet the expenses while in Japan (1) Method of support and an amount of support per month(average) self yen remittance from abroad Scholarship (2) Supporter name address occupation place of employment () annual income in local currency currency unit yen yen Please state supporters information below (2)

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Chuo University 8/8

Declaration and Certification of Finances

Name of Student Home Institution : Please note: In order for a Certificate of Eligibility for a Status of Residence to be issued by the Immigration Bureau, Japanese Ministry of Justice, you must submit complete and accurate information regarding your sources of financial support. You are required to submit current evidence that you will have at least \100,000 per month for the entire length of time you plan to study at Chuo University. Be sure to attach verification of the financial statement by means of a bank statement indicating saving balance, a bank remittance, a copy of a bank book which indicates a proof of remittance or a certificate of remittance, an official letter from the scholarship foundation indicating the amount and duration of the scholarship, or other official evidence of cash available and transferable. Chuo University will not apply for the Certificate of Eligibility for you if you dont attach the verification. ----------------------------------------------------------------------------------------------------------------------------------------- Resources for educational and living expenses in Japan [ ] Personal: If you, a member of your family, or other individual will provide the funds for your educational and living expenses, the following oath must be completed: I, (name of the sponsor), hereby sign this oath to take responsibility for the living expenses during the stay in Japan of (name of the student). I hereby submit a bank remittance document or a copy of a bank book which indicates a proof of remittance or a certificate of remittance. Tuition: (Waived for exchange student.) Living expenses: \ Method of payment: Signature of the sponsor: Relationship to the student: [ ] Myself [ ] Other (Please specify: Date: [ ] Scholarship: If you are sponsored by the government, agency, private grant or scholarship, you must complete the following financial statement. Please do not write the JASSO/Monbukagakusho scholarships here. Chuo University cannot guarantee that you will be accepted as a grantee by JASSO/Monbukagakusho. You should not rely on the JASSO/Monbukagakusho scholarships and you should be prepared to finance your study period in Japan on your own or by other scholarships of your country. Name of the scholarship Amount of the scholarship per month Duration of the scholarship I certify that the above information is true and complete to the best of my knowledge. I am fully aware that any false or misleading statement may result in an automatic denial of my admission request or eventual dismissal from Chuo University. Signature of the student Date per month for months.

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