ASEAN-Japan BUILD-UP Cooperative Education Program

For Global Human Resource Development in Earth Resources Engineering, Kyushu University
Application for Course Admission
Date/ Month/ Year: / /
Program Leader:
Koichiro Watanabe
Professor
Faculty of Engineering, Kyushu University

I wish to apply to the ASEAN-Japan BUILD-UP Cooperative Education Program, with a good
understanding of the objectives and the education program. I agree to be under consultation and
supervision of my host professor.

Name in full (Typed) [Passport Name] :

*Write your name exactly same as is printed in your passport

Name in Chinese characters if applicable:

Signature _______________________________________

Nationality:

Male Female

Please choose your preferred group for School on the Move:

Group A (Mining/Mineral Processing/Petroleum) Group B (Geology/Geophysics/Geothermal)

Faculty/Department: ________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Laboratory: _____________________________________________________________________________
University: _______________________________________________________
Supervisor:

Student ID No.: ___________________

TOEIC/TOEFL/IELTS Score ___________________

Tel: ( ) (ext.: )
Mobile phone: ( )

E-mail: ___________________@______________________________________

MEAL REQUEST:
Normal Muslim Meal Hindu Meal Vegetarian Meal
Supervisors recommendation comment