Application Form for the Interview of

University of Yamanashi Special Educational Program on River Basin Environmental

Science October 2023 Enrollment

NAME

DATE OF BIRTH (Day/Month/Year)

SEX
□ MALE □ FEMALE

CURRENT OCCUPATION (with the name of the university currently attending or the name and place of
employment)

UNIVERSITY EDUCATION (Names of University, Department and Major)

Main language used in the course and classes: □English □Others( )

DATE of GRADUATION / EXPECTED DATE of GRADUATION (Month and Year)

PREVIOUS SUPERVISOR

TITLE OF MASTER’S
(BACHELOR’S) THESIS

Please choose your desired main supervisor and research topic by referring to the supervisors list.

DESIRED MAIN SUPERVISOR

DESIRED RESEARCH TOPIC