Application for Exemption from Submission of English Test Scores

Tokyo Institute of Technology Global Scientists and Engineers Program Commencing in April 2020
*This form is only for applicants who are requesting exemption from submitting TOEFL, TOEIC, or IELTS test scores.

To: The Department of Transdisciplinary Science and Engineering,

School of Environment and Society, Tokyo Institute of Technology

I hereby apply for the Tokyo Institute of Technology Global Scientists and Engineers Program,
and after having attached the required document ** , request exemption from the submission of TOEFL, TOEIC,
or IELTS test scores.

1. Name in Full (In Roman block capital letters) 2. Sex

 Male
 Female
(FAMILY NAME) (GIVEN NAME) (MIDDLE NAME)

3. Date of Birth (Year／Month／Day) 4.nationality

／ ／
( Year ／Month ／Day Age [As of April 1, 2020] )

Tel: ( )
Current
Fax: ( )
Address
Email:

**Required document: Photocopy of applicant's passport

P l e a s e e m a i l t h i s a p p l i c a t i o n f o r m a n d a c o p y o f y o u rn yp ua .sgs apko@
r t j it m
o . t i t e c h ,. at ch.ej pU n d e r g r a d u a t e A d m i s s i o n s
Group, Student Services Department of Tokyo Institute of Technology.