Form 1 (Page 1)
Application Form for Admission
Arid Land Resources Science Course for Doctoral Program (Global30) - Year 2016
1. 氏名(Full Name)
(1)自国語 In the language of your country
,
氏 Last Name
,
,
名 First Name
写真 Photo
4cm × 5cm
Middle Name
(2)ローマ字 In Roman letters (パスポートに記載の英字氏名)
Must be identical to your name in Roman letters on your passport
,
氏 Last Name
2. 国籍等 Nationality
,
,
名 First Name
Middle Name
3. 生年月日 Date of Birth
性別
未既婚の別
母語
Sex
Marital Status Native language
□男 Male
□未婚 Single
年 Year 月 Month 日 Day 年齢 Age □女 Female □既婚 Married
4. 現職 Present Status (在学大学または勤務先の名称および住所 Name and Address of current university or employer)
□ 在学 Student
□ 在職 Employed
Tel:
□ 無職 Unemployed
Fax:
□ その他 Other
E-mail:
5. 現住所 Present Address (include zip-code, if any)
Tel:
Fax:
E-mail:
6. 緊急時の連絡先(現住所以外の本国のものを記入) Contact address in case of emergency (Please use the address in
your home country but other than present address indicated above)
Tel:
Fax:
E-mail:
7. 選考結果送付先氏名・住所・電話番号 Name and address to whom results should be sent
（上記 5 と同じ場合は記入不要 Not required if it is the same as one indicated above in 5)
Tel:
Fax:
E-mail:
8. 志望専攻名 Name of prospective academic advisor’s
division
9. 志望指導教員名 Name of prospective academic
advisor
10. 研究課題 Research Topic
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Form 1 (Page 2)
11. 学歴 Educational Background
学校教育
Education
学校名・所在地・専攻・取得学位(資格)名
Name and address of school, major and
title of diploma or degree awarded
初等教育
Elementary Educ.
[小学校]
Elementary School
中等教育
Secondary Educ.
[中学校]
Lower Secondary
School
入学 From
Yr.,
Mon.
卒業 To
Yr.,
Mon.
[
年 Years]
学校名 Name of school
所在地 Location
入学 From
Yr.,
Mon.
卒業 To
Yr.,
Mon.
[
年 Years]
学校名 Name of school
所在地 Location
[高 校]
Upper Secondary
School
学校名 Name of school
高等教育
Higher Education
[大 学]
Undergraduate
School
学校名 Name of school
[大学院]
Graduate School
学校名 Name of school
入学・卒業年月日
[自己の修学年数]
Dates of entrance
and graduation
[Number of years
attended]
入学 From
Yr.,
Mon.
卒業 To
Yr.,
Mon.
[
年 Years]
所在地 Location
住所 Address
取得学位(資格)名 Diploma or degree awarded
住所 Address
取得学位(資格)名 Diploma or degree awarded
以上を通算した全学校教育修学年数
Total number of years of schooling as given above
入学 From
Yr.,
Mon.
卒業 To
Yr.,
Mon.
[
年 Years]
入学 From
Yr.,
Mon.
卒業 To
Yr.,
Mon.
[
年 Years]
年 Years
正規の修学
年数
Required
number of
years of
schooling
年
Years
年
Years
年
Years
年
Years
年
Years
年
Years
休学等,在籍中に修学を中断した期間(理由) Periods of interruption of studies, if any. Please indicate the reason in ( ).
From
(
From
(
年 Yr.,
月 Mon. ～
年 Yr.,
月 Mon. ～
年 Yr.,
)
年 Yr.,
)
月 Mon.
月 Mon.
2
Form 1 (Page 3)
12. 職歴 Employment record, beginning with the most recent position, if applicable.
勤務先および所在地
勤務期間
役職名
Name and address of employer
Period of employment
Position
From
To
～
職務内容
Type of work
～
～
～
13. 他大学への応募状況 Application to other universities
□応募している。 Yes
応募している大学名
Name(s) of other university you are applying:
□応募していない。No
私は、貴学に入学を希望し、出願書類等を提出します。なお、私が貴学に提出した出願書類等の全てに関
して、記載事項等に虚偽があった場合は、入学許可を取り消されても意義を申し立てません。
I hereby submit my application for admission to the University of Tsukuba. I fully understand that my application
becomes invalid if it is found that I have declared any false information or misrepresented myself within this
application.
出願者氏名
Applicant
Name
________________________________________
署
名
Signature
________________________________________
日
Date
________________________________________
付
3
Form 2
Research Plan
Arid Land Resources Science Course for Doctoral Program (Global30)- Year 2016
Graduate School of Life and Environmental Sciences, University of Tsukuba
Name of Applicant
Prospective Academic Advisor
(Please circle the contact
history/method with the academic
advisor to prepare the plan of study)
(Email-Internet/Conference/Education Fair/In-person Meeting)
Describe your motive for the application and research plan in English within 1,000 words. If necessary, you may
describe additional information on a separate A4 size sheet and attach it to this form.
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Form 3
Payment Receipt of Examination Fees
Arid Land Resources Science Course for Doctoral Program (Global30)- Year 2016
Graduate School of Life and Environmental Sciences, University of Tsukuba
Name of Applicant
Please paste or attach the payment receipt here.
5
Checklist
Graduate School of Life and Environmental Sciences
University of Tsukuba
Checklist for Application to English Course
“Arid Land Resources Science Course for Doctoral Program (Global 30)”
Necessary Documents
Description
Check

1
Application Form for
Admission
Form 1
☐
2
Research Plan
Form 2
☐
3
Examination Fee
Receipt, Form 3
☐
4
Recommendation Letter
Dean/Academic Advisor/ Head of the
Institute
☐
5
Supervisor’s Agreement
☐
6
(Expected) Graduation
Certificate
Prospective supervisor’s Agreement
Letter
Expected Graduation Letter of
Master’s Degree
7
Degree Certificate
Graduation Certificate of Master’s
Degree
☐
8
Transcript
☐
9
Research Achievements
Official Transcripts of Bachelor’s and
Master’s Degrees
Publication List
10
Certificate of Sponsorship
Supported by the Funding Agency (If
any)
☐
11
TOEFL/TOEIC/ IELTS
Test Results.
Official English Test Records
☐
☐
☐
I hereby submit my application along with all the necessary documents listed above for admission to the Doctoral
Program at the University of Tsukuba. I fully understand that my application becomes invalid if it is found
incomplete or there is any misrepresentation of myself within this application.
Applicant Name ______________________________
Signature
__________________________________
Date
__________________________________
6