Kobe University Graduate School of Medicine (Ph.D Course)
Application Form for Admission in October 2015 and April 2016
For international applicants taking the English language examination
*Examination number:
(Leave this space blank)
Paste your photograph
taken within the past
INSTRUCTIONS
3 months.
１．The application should be typewritten or handwritten in Roman block letters
Write your name and
.
nationality in block letters
２．Numbers should be Arabic numerals.
on the back of the photo.
３．Years should be written using the Anno Domini system.
(4.5×6.0cm)
４．Proper nouns should be written in full, and should not be abbreviated.
Fill-in Date 2015,
Year,
,
Month,
Date
１．Name in full
In native language
，
Family name
In Roman block
，
First name
Middle name
，
，
Family name
First name
Pronunciation (Japanese KATAKANA or HIRAGANA)
Middle name
２．Nationality
３．Date of birth
，
Month
19
Year
４．Enrollment period
a) October, 2015
，
Date
．
Age
b) April, 2016
５．The division you wish to apply to
(Division)
(Professor)
６．Present address and telephone number, facsimile number, E-mail address
Present Address：
Telephone/Fax number：
E-mail address：
７．Person to be notified in applicant's home in case of emergency:
Name in full：
(Relationship)
Present address：
Telephone/Facsimile number：
E-mail address：
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(Sex)
□Male
□Female
８．Educational background
Name and Address of School Year and Month
Period of
Diploma or
Schooling you Degree awarded
Of Entrance
And Completion have attended
Major subject
Name
From
Location
To
yrs
Elementary Education
and
Elementary School
mons
Name
From
Location
To
yrs
Secondary Education
Lower Secondary
School
Upper Secondary
School
and
mons
Name
From
Location
To
yrs
and
mons
Name
From
Location
To
yrs
Higher Education
and
Undergraduate Level
mons
Graduate Level
Name
From
Location
To
yrs
and
mons
Total years of schooling mentioned
yrs
above
＊If the blank spaces above are not sufficient for information required, please attach a separate sheet.
９．Present status : with the name of the university attended or of employer.
I hereby declare that the above to be true and correct.
Date
Name
Signature
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Examination Slip 1
Kobe University Graduate School of Medicine (Ph.D Course)
For international applicants taking the English language examination
*Examination number:
Paste your photograph
taken within the past
3 months.
Write your name and
nationality in block
letters on the back of
the photo.
(Leave this space blank)
Name (In native language):
□Male
□Female
Name (In Roman block):
(4.5×6.0cm)
Date of birth:
Enrollment period:
a) October, 2015
b) April, 2016
The division you wish to apply to:
* Bring this Examination Slip 1 on the day of entrance examination.
* Successful applicants are needed to submit this slip on the day of enrollment formalities.
Payment Confirmation
Examination Slip 2
(Examination fee by remittance abroad)
*Examination Number:
(Leave this space blank)
*Examination Number:
(Leave this space blank)
The division you wish to apply to:
Name:
(In Roman block)
Name:
(In Roman block)
Date of Payment:
Paste your photograph
taken within the past
3 months.
Write your name and
nationality in block
letters on the back of
the photo.
Bank Name
(in your country):
Beneficiary Bank
□ Sumitomo Mitsui Banking Corporation
□ Bank of Tokyo-Mitsubishi UFJ
*Be sure to attach a copy of receipt.
(4.5×6.0cm)
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The remittance of the admission fee from the foreign countries
Guide for overseas remittance of admission fee (Kobe University).
The admission fee is 30,000 Japanese yen.
When paying from overseas, please be sure to make the payment in Japanese yen basis and remit 30,000 yen as
the application fee to the designated bank account mentioned below. You can choose the via bank less.
The remittance fees will be borne by the applicant, while Kobe University covers any other commissions
including lifting charge or handling fees. No overseas remittance checks will be accepted.
A photocopy of the remittance request form must be attached to your application form.
A designated financial institution
１．
Bank name
Bank code
Swift Code
Branch
Branch Code
Account No．
Sumitomo Mitsui Banking Corporation
0009
SMBCJPJT
Rokko
421
4165080
Recipient
Kobe University
Bank name
Bank code
Swift Code
Branch
Branch Code
Bank of Tokyo-Mitsubishi UFJ
0005
BOTKJPJT
Kobe-chuo
453
1164161
２．
Account No．
Recipient
Kobe University
In addition, please include the following information, if possible.
Purpose of Remittance： Admission Fee
Message to Payee, if any： Please indicate ”D55”：Applicant's full name”
＊ Please put ”D55” before your name.
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