Application Form for 6th ASCENT

by SAGE Tokyo Tech

You must fill in this application completely in English and send it as an e-mail attachment.
* Application deadline:
3rd October 2014 (Fri.) 11:59 pm JST(Japan standard time) for students from ITB, CU
31th October 2014 (Fri.) 11:59 pm JST(Japan standard time) for students from DLSU and
students from any other university
* The e-mail address: sage.tokyo.tech+ascent@gmail.com.
We use your information only for the selection of and implementation of 6th ASCENT.
Application form contents (5 pages in total):
0: Acknowledgement
1: Your personal information
2: Essay
3: Selection schedule (We will inform you of this soon)

0: Acknowledgement
Please check the below box after you affirmed the acknowledgement. We assume that you agree on
following cancellation regulation when you submit this application form. This regulation is aimed to
prevent applicants from throwing their right away in an irresponsible manner.
In case I have to cancel my participation, I will follow below cancellation regulation.
Cancellation fee: 20 of participation fee (After 28th February 2015)
Nothing
(Until then)

1: Your personal information

Name in Alphabet

Name in Japanese Kanji

(if you have one)

Nickname (if you have one)

Male /

Sex

Female

Nationality

Date of birth(yyyy/mm/dd)

Tokyo Tech /

University

ITB / CU /
Other ()

Faculty/School

Department

Student Number (Tokyo Tech)

Select from the drop-down list

Number of semester
e-mail (university's official)(MUST!)

e-mail (private)

Which email address do you often

use?

Residential Address

Universitys official /

Private

Zip code, city

Country
Name
Relation

Emergency contact in your country

Can he/she speak

English?
Number

Mobile phone number

DLSU /

( +81,

+62,

+63,

+66,

+)

Skype ID / Google hangout

(for Interview)

How did you know ASCENT?

Application form is continued.

Skype:
Google Hangout:
International affair of your university, Website,
Facebook, Twitter, Flyer, Digital announcement
board, Teacher(class), Friend, Student
association, mail news (what kind of?: ),
Other()

2: Essay
Please answer following questions in English.
1: Why do you want to participate in ASCENT program? (Max. 200 words)

2: How can we solve the energy problem in the future? State a problem in describe the solution.
(Max. 250 words)

3: What do you think is important in having discussions among the youth from different places
from the world? (Max. 150 words)

3: Interview schedule
After you pass the paper screening, you will have an interview with the staffs in your country.
We plan to hold the interview session from 16th to 30th Oct. with them. The instruction of it will be
announced soon.
This is the end of the application form. Thank you.