AIMS Programme (TUAT) PHOTO

(4 x 3 cm)
Application Form Write your name in
block letters on the
back and paste it.
Please use BLOCK/CAPITAL letters.

1 Initial Applicant Information

1.1 Title Family name First name Middle name

1.2 Preferred first name/nickname Date of birth (dd/mm/yyyy)

・ ・ Gender Male Female

1.3 Current address

Number and street

Town/Suburb State/Country p/code

Telephone (home) Email

1.4 Contact address in case of emergency

Title Family name First name Middle name

Preferred first name/nickname Date of birth (dd/mm/yyyy)

・ ・ Gender Male Female

1.5 Please state your country of birth

1.6 Nationality Marital Status Single Married

1.7 Religion We welcome and accept applications from people of all faiths or none at all.

1.7 Meal restrictions

Halal Vegetarian Other allergies

2 Home University Information

2.1 Name of University

2.2 Name of School / Faculty

2.3 Current School Year

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3 Educational Background

Period of Attendance Required Years of

Classification Name of School Address of School
(YYYY/MM)) Study
From
Elementary ／
School To
／ Years
From
Lower and Upper
／
Secondary
To
School
／ Years
From
Undergraduate ／
Level To
／ Years
Total Years of Schooling Mentioned Above Years

4 English Proficiency
Attaching a TOEFL iBT, TOEIC, IELTS or CPE official test scores
Specify the detail below.
Name of the test

Date of the test Score/Classification

The language of the programme is my first language

A verification issued by a language lecturer which verifies that my language level is

equivalent to the proficiency level of TOEFL score of 500 (PBT)

5 Information necessary for the issue of the Certificate of Eligibility (COE)

5.1 Intended place to apply for visa

5.2 Past entry into/departure from Japan Yes No

Fill in the followings when the answer is "Yes"

time (s) The latest entry from Year Month Day

to Year Month Day

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5.3 Criminal Conviction Please indicate whether you have been convicted of a criminal offence
Yes No

5.4 Departure by deportation/departure order Yes No

Fill in the followings when the answer is "Yes"

time (s) The latest departure by deportation Year Month Day

5.5 Family in Japan Yes No

Intended to reside with Place of Residence

Relationship Name Date of birth Nationality applicant or not employment/school card number

6 Accommodation
Please choose your own preferred accommodation from the following options. These
will be assigned on a first-come-first served basis when applying.

On-campus residence (Shared Flat)

10.000 JPY/month + Cleaning expenses (15.000 JPY)
Utility bills are included. Internet is not included.

On-campus residence (Single)

28.000 JPY/month + Cleaning expenses (15.000 JPY)
Utility bills are not included.

Off-campus residence (Shared Flat)

20.000 JPY/month + Cleaning expenses (15.000 JPY)
Utility bills are not included.

Photos of the off-campus residence

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7 Motivations for the TUAT
Motivation to apply for the programme (max 500 words in English)

8 Courses you wish to register

List courses you would like to take below.
※ You are required to take classes that would sum up to the minimum of 14 credits

Code Department Course Title Credits Note

e.g. K1 Chemical Engineering Separation Process 3

Research Internship
e.g. P6 Applied Physics 2～3
P-5 Biophysics

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9 Declaration
I certify that all the information provided in this form and the accompanying documents
is complete and accurate to the best of my knowledge, and if admitted, I agree to
comply with the rules and regulations of Tokyo University of Agriculture and Technology
and the Japanese domestic law.

I will also carry comprehensive health insurance valid in Japan, e.g. travel insurance.

Name of applicant (in block letters)

Signature of applicant

Date (DD/MM/YYYY)

Name of the AIMS programme

coordinator (in block letters)

Signature of applicant

Contact address
(Address, Email, Phone number)

Date (DD/MM/YYYY)

10 Applications must be sent or delivered to

Takako Ochi

Associate Professor (AIMS Coordinator)

Tokyo University of Agriculture and Technology
Faculty of Engineering

2-24-16 Nakacho Koganei Tokyo Japan

184-8588
Tel: +81-42-388-7989
Fax: +81-42-388-8013
Email: tochi@cc.tuat.ac.jp

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