Form: J-ShIP 1

Center for International Education and Exchange

Osaka University
J-ShIP 2012
Japanese Short-term In-session Program
APPLICATION
NOTE:
- This application is designed to be filled out by using Acrobat Reader
- An applicants has to write an essay under the title of ‘MY Paste your photograph
(3  4 cm), taken within
EXPECTATION TO J-ShIP’．(A4: 1page, double-space) in English, then the last 6 months here.
enclosed the essay with other documents. Your name should be
- Numbers should be written in Arabic numerals. written in block letters
on the back.
- Years should be written according to Western calendar.
- Proper nouns should be written in full, no abbreviations.

I. PROGRAM TO APPLY
Program Title: Japanese Short-term In-session Program 2012 (J-ShIP 2012)
Program Option and Duration: J-ShIP Winter (Dec.17-Feb.04)

II. PERSONAL DETAIL/CONTACT

1. NAME IN FULL *The name written should be the same as in your passport.

Family name First name Middle name

Name in Chinese characters (if applicable) Initial

2. Nationality 3. Gender 4. Date of birth

Dec.
□ Male □ Female 19
Year Month Day

5. Mailing address
Address:
Tel: Fax: E-mail:
Mobile:

6. Permanent address
Address: Tel:

7. Emergency contact
Name in full: Relationship:
Address:
Tel: Fax: E-mail:
Mobile:

J-ShIP Winter (Dec.17-Feb.04)

 Form: J-ShIP 2
III. HOME INSTITUION
1. Home university
University:

M1
Faculty / School: Current School Year:
Major1: Major 2: Minor:
Dec.
2. Expected graduation/completion
Year Month

3. Educational background (beginning from the last high school you attended)

Entrance Completion
Institution Name and location of institution Major field of study
Year Month Year Month

College/
University

Others

4. GPA of the previous year; / 4.0

IV. LANGUAGE PROFICIENCY/BACKGROUND

1.Proficiency and Study Experiences of Language (Mark where appropriate.)

not at all lower intermediate mother
Language elementary
beginner intermediate or higher tongue
Japanese □ □ □ □ □
English □ □ □ □ □
(Other)
□ □ □ □ □

2. Applicant should understand that J-ShIP Summer and J-ShIP Autumn are programs for
Japanese learners of beginner levels. Also, lower intermediate learners may join J-ShIP
Winter. Revise the Section I of this form, in which you have chosen as the Program
Option. To avoid foreseeable confusions in the class, Osaka University will be forced to
reject applicants who have too high or too low proficiencies for each J-ShIP option.

 Please state your JLPT test score, if applicable

Year Month Day

 Please state your Japanese study background if any:

※ uncountable
hours at anywhere

J-ShIP Winter (Dec.17-Feb.04)

 Form: J-ShIP 3
Certification
Applicant Section
I hereby certify that my statements on this application are true and complete to the best of my
knowledge, and understand that any willfully false statement is sufficient cause for rejection of the
application, or if I have been admitted to spring intensive program, for dismissal from the program. I
also certify that once I am successfully enrolled in the program, I should respect the university
regulations and the instructions of the university staff.

I also fully understand that J-ShIP participants are obliged to pay tuition fee and some related program
fees to Osaka University prior to the program begins, regardless any memorandums between their home
institutions and Osaka University or individual scholarship status.

I hereby apply for admission to the J-ShIP program with a full understanding of the conditions and
requirements mentioned in J-ShIP.

Date: Signature of applicant:

Coordinator / Officers Section

As a coordinator / student exchange officer of the above student at ( ),
I solemnly confirm that above student is a full-time student of the institution and that the information
provided in this application form is true and correct to the best of my knowledge. I also authorize any
other person or organization to supply information to Osaka University regarding this application.

Name: (block letters)

Date:

Position:

Signature:

Contact TEL:

FAX:

E-mail:

J-ShIP Winter (Dec.17-Feb.04)