Application Form for Admission (Doctoral Course)

GraduateSchoolofScienceandTechnology,EducationDivision,ShizuokaUniversity
Instructions
ApplicationshouldbetypewrittenorhandwritteninRomanblockcapitals
NumbersshouldbeinArabicnumerals
Propernounsshouldbewritteninfull,andnotbeabbreviated.

Name in full, in native

language

Examinee Number
Family name,

First name,

Middle name
Nationality

Name in Roman block

capitals
Family name,

First name,

Middle name

Name in Japanese
Katakana if known

Sex
Family name,

First name,

Middlename

Date of birth

Marital Status
Year,

Month,

Day ,

Age

Desired Department
Nanovision Technology
(mandatory, check one) Optoelectronics and Nanostructure Science

Enrollment Period

Names of professors you wish to be yo

supervisors (mandatory)

Information Science and Technology

(1)

Environment and Energy System

Biosciences

(2)

April, 2016

October, 2015

Research topic (maximum 30 words)

Title of the presentation for oral exam

Type of Selection (mandatory, check one)
General Selection
Selection for Working Students
Selection of Foreign Students
University

Type of Qualification for Application (check one)

Qualification (1)
Qualification (2)
Qualification ( )
Graduate school

Financial background (check one)

Monbukagakusho Scholarship
Government Scholarship
Privately financed

The highest level of

Academic Achievement
Year,

Month,

Day
Completed

will complete

Present address
Telephone Number
Cellular phone number

e-mail

Permanent address
country
If you have(had) Monbukagakusho Scholarship, fill in the following details.
Name of Institution where you study(studied)
started (from)

finish(ed) (to)

year/month

year/month

If you have SKYPE ID, fill following column.

ID:
Spaces marked with an asterisk (*) are to be left blank.

Name of supervisor

ity

Male
Female

Single
Married
professors you wish to be your
rs (mandatory)

background (check one)

kagakusho Scholarship
ment Scholarship
y financed
Department

Family background
relationship

Neme

age

occupation

father
mother
spouse
Parents' address
Telephone Number:
Contact person in your home country in case of emergency
Name in full

Relationship

Occupation

Address
Telephone/Fax Number
Educational background

e-mail
Name and address of school

Elementary Education

school name

Elementary School

requisite year and period of

years of month of schooling
schooling entrance
and
from
yrs

degree (if
applicable)

major

yrs

location

to

school name

from

and mos
Secondary
Education

Lower

yrs

yrs

location

to

school name

from

Secondary
School

and mos
Upper

yrs

yrs

location

to

school name

from

and mos
Higher Education
Undergraduate Level

yrs

yrs

location

to

school name

from

and mos
Graduate Level

yrs

yrs

location

to

school name

from

and mos
Research Student

yrs
location

yrs
to
and mos
Total Years of Schooling

Current School Year/Grade

Employment Records
Name and Address of Organization

Period of Employment
from

Position

Type of Work

to
from
to
from
to

I understand that withholding information required in this application or giving false information may make me ineligible for addmision to, or continuation in,
Shizuoka University. With this in mind, I certify that the statements iabove are correct and complete.
Date

Signature

Applicants who intend to apply in accordance with Qualification for Application (6) or (7) only
Year,
Month,

Day

Application for Recognition of Academic Requirement

to Dean
Graduate School of Science and Technology, Education Division
Shizuoka Univeristy
Name in Roman block capitals

Name in Katakana if known

Date of Birth

Year,

Month,

Day

For individual evaluation of academic requirements as an applicant to the Graduate School of Science
and Technology, Education Division,
Department of
.
I hereby apply for admission with enclosed accompanying documents.

For official use only.

Academic Requirements
YES
NO

Chairperson of Department

Supervisor Professor

Name in full, in
native language

Nationality
Family name,

First name,

The highest level of

academic achievement
(univeristy/graduate school,
year)
Present status

Middlename

Sex

Male
Female

Marital Status

Single

Married
Names of professor you wish to be
your supervisors (mandatory)

(univeristy/company/organizat
ion, title)
Present address

(1)
(2)

TELEPHONE
e-MAIL
Educational background

Secondary Education

Name and address of school

year and month of degree

entrance and
(if applicable)
completion

school name

from

location

to

school name

from

location

to

school name

from

location

to

school name

from

location

to

major

Secondary School
high school

Higher Education
Undergraduate Level

Graduate Level

Research Student

Employment Record
Name and Address of Organization

Period of
Employment
from
to
from
to

Position

Type of Work


Research Plan

Examinee Number

Name in full, in
native language
Family name,

First name,

Desired Department Nanovision Technology

Middle name

Names of professors you wish to be your supervisors

Optoelectronics and Nanostructure

Science
Information Science and Technology

(1)

Environment and Energy System

(2)

Biosciences
Spaces marked with an asterisk(*) are to be left blank.

Outline your major field of study and plan and research in our graduate school. Statement must be typewritten or written in block
letters. You can use the back side of this sheet if necessary.

*
Nationality

ssors you wish to be your supervisors

Spaces marked with an asterisk(*) are to be left blank.

ol. Statement must be typewritten or written in block


Summary of Research and Technological Achievement

Examinee Number

Name in full, in
native language
Family name,

Desired Department Nanovision Technology

First name,

Optoelectronics and Nanostructure Science

Information Science and Technology
Environment and Energy System
Biosciences

Middle name

Names of professor you wish to be your supervisor

(1)
(2)
Spaces marked with an asterisk(*) are to

*
Nationality

professor you wish to be your supervisors

paces marked with an asterisk(*) are to be left blank.


Record of Research and Technological Achievement
Name in full, in native
language
First name,
Family name,

Desired Department Nanovision Technology

Optoelectronics and Nanostructure Science
Information Science and Technology
Environment and Energy System
Biosciences

State the title of published papers, book

chapters, books and thesis, titles of
papers presented at International
Conferences, etc. (if any), and the title of
patents and inventions, etc.

Vol., pages, year and date

in which thesis was
published
Year of International
conferences, etc.

Middle name

Names of professors you wish to be your supervisors

(1)
(2)

Title of journals

Title of International
conferences, etc.

Note(1). Attach reprints or copies of published papers, master's thesis, or proceedings of conferences. These will be
returned to the applicant after the examination.
(2) You may add additional pages if necessary.

Nationality

es of professors you wish to be your supervisors

Names of all authors

oceedings of conferences. These will be

 April Admission, 2016

October Admission, 2015

April Admission, 2016

October Admission, 2015

Examination Card

Examinee

)
Graduate School of Science and Technology, Education Division
Shizuoka University
Number
*

Name in Roman Block Capitals

Name in Japanese Katakana

Desired Department

Type of Selection

Selection of Foreign Students

April Admission, 2016
Admission Period

October Admission, 2015

Highest level of Academic Achievement /
University

Graduate School

Major

1. Spaces marked with an asterisk(*) are to be left blank.

2. Keep this card until admission.
3. Applicants will not be admitted to the examination room without
this card.

Photo ID Card

Examinee

Name in

Date of

Desired

Type of

Number

)
Graduate School of Science and Technology, Edu
Shizuoka University
*

Roman Block Capitals

Birth

year

Department
Selection

Selection of Foreign Students

April Admission, 2016
Admission Period

October Admission, 2015

Highest level of Academic Achievement /
University

Graduate School

Major

Spaces marked with an asterisk(*) are to be left blank.

ce and Technology, Education Division

month

day

Photo / (5.5cm x 4cm)

1. Paste a photo (from the
chest up) taken within the
past 3 months.
2. Write your name and
nationality in block
letters on the back of the
photo.


Return Seal

Address for the Examination Card

Name
Address
Street

City

Zip code

Country

Address for the Notification

Name
Address
Street

City

Zip code

Country

Permission for Examination

Date:
The President
Graduate School of Science and Technology,
Shizuoka University
836 Ooya, Suruga-ku
Shizuoka-shi
Japan 422-8529

I permit that the following person will take an

Entrance Examination in (October, 2015
or
April, 2016).

Examinee's Name
Date of Birth

ll take an
15
or

Application Checklist
This checklist has been provided for your convenience. If you have any questions, please contact Graduate School Office.
Application for Admission
1,
2,
3,
4,
5,
6,
7,
8,
9,
10,
11,
12,
13,
14,
15,
16,
17,
18,

Application Form
Examinaton Card and Photo ID Card
Research Plan
Official Certificate of Achievement of undergraduate school
Official Certificate of Achievement of graduate school
Official Certificate of Graduation of graduate school
Official Proof of Graduation of graduate school
Official Certificate of Academic Record
Copy of Master's thesis and its summary
Summary of Research and Technological Achievement
Report of Master's thesis
Official Certificate of having passed the Qualifying Examination
Permission for Examination
Non-refundable Application Fee
Return Seal
Letter of Recommendation
Copy of Passport
Presentation file for internet Interview

: All applicants
*1 : Applicants who work for any public office or company
*2 : Applicants of Special Selection for Working Students if any
*3 : International Students

After you have checked, please send all required documents to

Graduate School Office

Graduate School of Science and Technology
Shizuoka University

Application for Indivisual Evaluation

Qualifications(1)-(5),(9)
Qualifications(1),(3),(4),(5),(9)
Qualifications(2),(4)
Qualifications(6),(7),(8),(9)
Qualifications(1),(3),(4),(5)
Qualifications(1),(3),(4),(5)
Qualifications(2),(4)
Qualifications(9)
*1

*2
*3

Application Form for Individual Evaluation

Official Certificate of Undergraduation of gradua
Official Certificate of Achievement of undergradu
Summary of Research and Technological Achieve
Record of Research and Technological Achievem
Copies of any Academic Research Publications, e
Envelope for the Result Notification

3-5-1 Johoku naka-ku, Hamamatsu 432-8011

JAPAN

al Evaluation

vidual Evaluation
dergraduation of graduate school
ievement of undergraduate school
Technological Achievement
echnological Achievements
Research Publications, etc