APPLICATION FORM TO GRADUATE PROGRAM

for October 2021 Enrollment

Department of Civil Engineering, Yokohama National University

Note to Applicant: This application form consists of five pages. Type or print clearly.
This form must be submitted with other necessary documents.

1.-1 Program applied: □ Doctoral program □ Master program

1.-2 Select one/both program(s) you prefer to apply.
If you select both, indicate your 1st preference in ( ).
□ Civil and Development ( )
□ Civil and ICT/IoT ( )
* This program is carried out with JICA’s program of
“Innovative Asia”. (e.g. support for internship)

2.Field of study applied: □ Civil engineering

3.Name in full in native language ,

(Surname) (Given name) (Middle name)

In Roman block capitals ,

(Surname) (Given name) (Middle name)
* Please write your name exactly as it appears in your passport.

4.-1 Nationality: 4.-2 Japanese nationality

□Yes, I have.
Attach here a
recent photograph
□No, I don’t have it.
taken within the
last 6 months

5. Sex: □ male □female

(4.5cmx3.5cm)
6. Marital status: □single □married

7. Date of birth: 8. Age (as of April 1, 2021):

9. Mailing address (Give address where you are surely contacted until October 2021.
If you plan to move, give present address and future address and show valid period.):

Present address:
Telephone number:
Facsimile number (if available):
E-mail address:
 10.Field of specialization studied in the past（Be as detailed and specific as possible.)

11. Academic Background:

Year and Month Diploma or Degree
Name and Address Duration of
of Entrance and Awarded, Major Subject,
of School Attendance
Completion Skipped Years/Levels
Name From
Primary years
Education
and
Elementary Location To
School months

Name From
years
Secondary
Education and
Location To
Middle School months

Name From
years

High School and *-1

Location To
months

Name From
Tertiary years
Education
and
Undergraduate Location To
Level months

Name From
years

Graduate Level and

Location To
months

Total number of years of the aforementioned

schooling (as of April 1, 2021) years
Notes:
１．Exclude kindergarten education and nursery school education.
２．Preparatory education for university admission is included in secondary education.
３．If the applicant has passed the university entrance qualification examinations, indicate this in the column with “*-1.”
４．Any school years or levels skipped should be indicated in the fourth column (Diploma or Degree Awarded, Major Subject,
Skipped Years/Levels). (Example: Graduated high school in 2 years.)
５．If you attended multiple schools at the same level of education due to moving house or readmission to university, then write
the schools in the same column and include the number of years of study and current status for each school.
６. Calculate and write the total number of years studied based on duration as a student. (including extended leave such as
summer vacation)
７. You may use a separate piece of paper if the above space is insufficient. In such a case, please stipulate that the information
is on a separate page.

12. If you have published any papers or books (including a graduation/master thesis
authored by the applicant), state the titles or subjects of the books or papers with the name
and address of the publisher and the date of publication.

13. Employment record (Write employed period, employer’s name, job title and job
description. Start with the most recent employment.):

period employer’s name job title and description

14. Other professional experiences if any:

15. Present status:

16. Field of interest (Select one of them.)

□1. Structural
□2. Estuarine and Coastal
□3. Geotechnical
□4. Transportation and Urban Engineering
□5. Concrete

17. Field of interest in detail and study plan at Yokohama National University:
*Use separate sheet and attach to this form.

18. Future plan after completion of the program:

19. Information of two referees who write a recommendation letter for you. (Two
recommendation letters in specific form should be sent directly to the Department.)

(1)
name title institution
(2)
name title institution

20. List of other graduate schools you are applying to:

21. Will you surely be able to come to Japan in the last week of September, 2021?
□ Yes □ No (explain reason.)

22. Japanese language proficiency: Evaluate your level and insert an X where
appropriate in the following blank space.
Excellent Good Fair Poor
Reading

Writing

Speaking

23. Language ability: Evaluate your level and insert an X where appropriate in the following blank
space.
Excellent Good Fair Poor

English

French

German

Spanish

24. Past awarded record

Have you been awarded a Japanese Government (Monbukagakusho, MEXT)
Scholarship in the past? Please check ⅰ ) orⅱ) below. If so, please specify the
period, the name of the university, etc.
□ⅰ) Yes, I have.
Period: University:
□ⅱ) No, I have not.
25. Accompanying Dependents (Provide the following information if you plan to bring
any family members to Japan.)
* All expenses incurred by the presence of dependents must be borne by the grantee.
He/She is advised to take into consideration various difficulties and the great
expense that will be involved in finding living quarters. Therefore, those who wish
to be accompanied by their families are advised to come alone first and let their
dependents come after suitable accommodation has been found.

Name Relationship Age

26. Person to be notified in applicant's home country in case of emergency

ⅰ） Name in full:

ⅱ） Address with telephone/facsimile number, and email address.

Present Address：

Telephone/facsimile number：

E-mail address：

Ⅲ） Occupation:

Ⅳ） Relationship to applicant:

27. Immigration Records to Japan

Date Purpose
From

To
From

To

28. I certify that I have read all instructions and that information in this application is true
and complete. I understand that misrepresentation may be cause for canceling my
admission. I understand that all credentials and documents I submit become the
property of Yokohama National University.

signature of applicant date