Form#1 (1/4)

Application for Admission

Type or write in a legible hand with black or blue ink. Check the appropriate boxes.

I. Personal Information
Photograph
1. Name LAST(FAMILY)       4 × 3cm
(1.6"×1.2")
(1) In English First(Given)      
Write your
Middle       last name
on the back.
(2) In Chinese Characters if applicable            
Last(Family) First(Given)

(3) In Japanese Katakana if applicable      

(4) The order of the name in your country.

Last-First First-Last Last-Middle-First First-Middle-Last
Other than the above (       )

2. Date of Birth       (Age:    years old as of April 1, 2011)

yyyy/mm/dd

3. Nationality       4. Marital Status Single Married

5. Present Status
Choose the most appropriate box.
Student: Undergraduate Master-level Doctoral-level
Employed: Teaching Position Research Position Company Employee Other

           
Status/Title Affiliation/Company (Do not abbreviate)

6. Return Mail Address to receive the notification from IGPAS Academic Affairs Section
Residence Office Other(      )
     
Address in English

     
Address in Chinese characters if applicable (Fill in the address in English above, too.)

                       

Country Postal Code Phone Fax (if available)

7. Email Address to receive emails from IGPAS Academic Affairs Section

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II. Application Status

1. Which program and department are you applying for?
Program Department
Master’s program Mathematics Physic Astronomy
Doctoral program Geophysics Chemistry Earth Science

2. Prospective Supervisor      

[NOTE] Applicants must obtain the consent of the prospective supervisor in advance of application. Attach
printouts of an email or any other proof to show that the prospective supervisor named above have agreed to
your application, if available.

☞Applicants for the doctoral program → Skip to 5.

3. Do you wish to apply for the MEXT scholarship by University Recommendation?

Yes, I wish to apply for the MEXT scholarship. → 4A & 4B
No, I do not apply for the MEXT scholarship. → 4C

4A. Have you received the MEXT (Japanese Government) scholarship before? YES NO
If YES, give the name of (1) program, (2) host institution, and (2) its term.
(1)      
(2)      
(3) From      /    to      /   
yyyy/mm yyyy/mm

4B. Do you intend to enter IGPAS even if you are NOT awarded the YES NO
MEXT scholarship?

4C. Are you applying for, or going to receive, any scholarship? YES NO
If YES, provide brief information of the scholarship.
(e.g. name/sponsor/duration/amount of the scholarship, when the result will be announced, etc.)
     

5. Are you applying to any other graduate schools? * YES NO

6. List institutions, programs, or positions you are currently applying for.* (OPTIONAL)
     

*The answer(s) will not prejudice your application for admission.

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III. Academic Background

1. Educational History
Number of
Level Name of School From To Academic Years
(Write in Chinese characters if applicable) (yyyy/mm) (yyyy/mm)
(a) (b)
Elementary
(Primary)
           /         /             
Lower Secondary
(Junior High)
           /         /             
Upper Secondary
(Senior High)
           /         /             
University
(Undergraduate)
           /         /             
University
(Graduate)
           /         /             

                 /         /             

                 /         /             

Total years of school education (as of September 30, 2011)          
(a) The period that you were, or are expected to be, enrolled in the school from admission to graduation.
(b) The period that the school usually requires students to complete the program. (e.g. 4-year university → 4)

2. Degree(s) Conferred
Bachelor Master Doctoral            
Degree Major/Department Date (yyyy/mm/dd)

     
Faculty, Institution

Bachelor Master Doctoral            

Degree Major/Department Date (yyyy/mm/dd)

     
Faculty, Institution

Bachelor Master Doctoral            

Degree Major/Department Date (yyyy/mm/dd)

     
Faculty, Institution

3. Additional Educational/Research Experience

     

Attach an additional sheet if the given space is not enough.

4. Honors and Scholarships
     

Attach an additional sheet if the given space is not enough.

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IV. Other Experiences

*This section will not prejudice your application for admission.

1. Have you had any full-time jobs? YES NO

If YES, provide the information on the two most recent jobs.
           
Term (from yyyy/mm to yyyy/mm) Company/Institution (Do not abbreviate)

           
Position Address or URL

           
Term (from yyyy/mm to yyyy/mm) Company/Institution (Do not abbreviate)

           
Position Address or URL

2. Have you been to Japan? YES NO

If YES, provide the information on the most recent (or longest) stay in Japan.
           
Term (from yyyy/mm to yyyy/mm) Purpose of Stay (e.g. Sightseeing, To participate in exchange programs, etc.)

V. Language
*This section will not prejudice your application for admission.

1. What is your primary (first) language?      

2. How proficient are you in Japanese?

　 Check all that apply.
Reading Not at all Hiragana Katakana Chinese characters (Kanji)
Writing Not at all Hiragana Katakana Chinese characters (Kanji)
Speaking Not at all Beginner Intermediate Fluent
Understanding Not at all Some words/sentences Papers/documents

3. List any English or Japanese proficiency tests you have taken. (OPTIONAL)
Attach a photocopy of the test result if available.

                 

Test/Level Date (yyyy/mm/dd) Result/Score

                 

Test/Level Date (yyyy/mm/dd) Result/Score

                 

Test/Level Date (yyyy/mm/dd) Result/Score

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Applicant Certification
I hereby certify that the information in this application form is true and complete.
I understand that falsification of the application information may result in denial of admission.

Signature Date       /    /   

yyyy/mm/dd