Entrance Application for October 2017 [Master's Degree Program]

For Japanese Government (Monbukagakusho/MEXT) Scholarship Students

Choose one of the programs which you wish to enroll.
□Biotechnology Global Human Resource Development Program
□Chemical Science Course
□International Program of Maritime and Urban Engineering

Date：　　　　　　 ,　

Application for Admission (International Students)

To : President, Osaka University

Name in full : ※ Sex : M / F

　[in Roman Block Letters]

(Family name) (First name) (Middle name)

　[in Katakana]

(Family name) (First name) (Middle name)

[in Chinese Characters]

(Family name) (First name) (Middle name)

　　I hereby submit my application form for acceptance to the Graduate School of Engineering, Osaka University
　 as an international student of the Master's Course with Monbukagakusho scholarship.

Nationality/ Marital Status

Region
※　Single　/　Married
Photo
（4 cm × 3 cm）
Date of Birth 19　　　 　(year)　 　 　　(month) (day)
●Please write your name
on the backside.
Permanent
Address in
Home Country

〒
Present Address

E-mail ： TEL ：

Stamp by Academic
〈Notes〉 Affairs Division

・Proper nouns should be written in full, not abbreviated. ＊

・※ Circle the one that applies.
・＊ Do not fill in.
・Specify your academic background and employment history in detail.
-1-

Educational Background

Period of Attendance Degree Required Years

Classification Name of School Address of School (Bachelor
(yyyy/mm) /Master)
of Study

From
Elementary /
School To years
/
From
/
Lower and To years
Upper /
Secondary From
School /
To years
/
From
Undergraduate /
Level To years
/
From
/
Graduate Level
To years
/

/
years
/

Total Years of Schooling Mentioned Above

years
School and Faculty Period of Attendance(yyyy/mm) Details
From To
/ ～ 　　　/
Attach a proof of enrollment if you are
Research not a research student at the
Student From To School/Graduate School of Engineering,
/ ～ 　　　/ Osaka University.

From To
/ ～ 　　　/
If you have ever taken "Japanese
Japanese Language Proficiency Test" or
Language "Examination for Japanese University
From To Admission for International Students,"
School
/ ～ 　　　/ attach a photocopy of your results.
 State any experience of studying abroad
Others in countries (including Japan) other than
your home country.

-2-

Family Members (including those living outside of Japan)　

Does he/she live
Name Relationship Age Occupation Name of Organization with you in Japan?

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Research Interests (after enrollment)

Research Achievements
(List your research papers and publications, if any. Specify the title, name and address of publisher,
and date of publication of each paper. If you don't have any, specify what you have learned so far.)
Preferred supervisor: Specify your first, second and third choice of preferred supervisor.

-3-
 Employment History

Period of
Name and Address of
Emplyoment Position Type of Work
Organization
(yyyy/mm)

　/ ～ 　/

　/ ～ 　/

　/ ～ 　/

　/ ～ 　/

Japanese Language Proficiency : Self-evaluation. Circle one that applies.

Excellent Good Fair Poor Notes

Reading

Writing

Speaking

Foreign Language Proficiency : Self-evaluation. Circle one that applies.

Excellent Good Fair Poor Notes

English

French

German

Spanish
-4-
English proficiency : Attaching a TOEFL, TOEIC, IELTS or CPE official test scores as the certificate is
strongly recommended.
Specify the detail below.

Name of the test

Date of the test year month day Score/Classification

Scholarship:
Will you receive financial aid by a funding body? □　Yes 　　□　 No 　□ Now applying
If "Yes", state the name of the sponsor, duration, amount.

Person (living in Japan) to be notified in case of emergency

(not required for Monbukagakusho scholarship students)

Name Occupation Address

E-mail ： TEL ：

Do not fill in the following.

*
-5-