Entrance Application for October 2019[Master's Degree Program]

For Japanese Government

(Ministry of Education, Culture, Sports, Science and Technology: MEXT) Scholarship Students
Choose one of the programs which you wish to enroll.
□ Biotechnology Global Human Resource Development Program for Industry-University Co-Creation
□ Chemical Science Course
International Priority Graduate Program of
□
“Quantum Engineering Design Course”

Date：　　　　

Application for Admission

To : The President, Osaka University

Name in full : ※ Sex : Male / Female

　[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 a Japanese Government
(Ministry of Education, Culture, Sports, Science and Technology: MEXT) Scholarship.

Marital Status
Nationality/
Region 　　　　　　　※　Single　/　Married　 Photo
（4 cm × 3 cm）
Date of Birth 19　　　 / / 　(Year/Month/Day) *Please write your name
on the backside before
pasting.
Permanent
Address in
Home Country

Present Address Zip Code：

E-mail ： TEL ：

-1-
 〈Notes〉
・Proper nouns should be written in full, not abbreviated.
※ Circle the one that applies.

-2-
 Educational Background

Address of School
Name of School and Period of Attendance Degree Required Years
Classification (Country/Area and (Bachelor
Department (yyyy/mm) of Study
City) /Master)
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
School From To Admission for International Students,"
attach a photocopy of your results.
/ ～ 　　 　/
From To
/ ～ 　　 　/ State any experience of studying abroad
Others in countries (including Japan) other than
From To your home country.
/ ～ 　　 　/

-3-
 Employment History

Name and Address of Period of Emplyoment

Position Type of Work
Organization (yyyy/mm)

　/ ～ 　/

　/ ～ 　/

　/ ～ 　/

　/ ～ 　/

Family Members (including those living outside of Japan)　

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

Yes　 /　 No

Yes　 /　 No

Yes　 /　 No

Yes　 /　 No

Yes　 /　 No

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

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-
-5-
Scholarship:
1 Have you been awarded a Japanese Government (MEXT) Scholarship in the past? □　Yes 　　□　 No
If "Yes", state the program and duration.
Program: Duration: From (year) / (month) to (year) / (month)
2 Are you applying for any other scholarship? □　Yes 　　□　 No
If "Yes", state the name of the scholarship, duration, amount.

Research Interests (after enrollment)

Preferred supervisor: Specify your first, second and third choice of preferred supervisor（Full name).
No. Name Have you already contacted with him/her ?
1 　□　Yes □　No
2 　□　Yes □　No
3 　□　Yes □　No
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.)

-6-
-7-
 Name:

Check List (Check in the boxes provided.)

1 □ Application Form
2 □ Statement of Purpose
3 □ Certificate of (Expected)
Graduation / Completion
4 □ Certified Academic Records
5 □ Certificate of English Proficiency
6 □ Letter of Recommendation
7 □ Certificate of Citizenship
8 □ Abstract of Graduation Thesis

【Note】

1 All document are to be printed on A4 size paper whenever possible.

2 Submit original documents or certified true copies(with the exception of 7).

3 Once application documents have been received, they will not be returned.
 possible.

the exception of 7).

not be returned.