Sheet for Computation Treatment (Exemption/Deferment of Admission Fee)
(For privately–financed international students)
Example
* For students who wis h to apply onl y for the deferm ent of the adm ission fee ,
please m ake sure to check ( ✔) the right bo x.
Use a pencil to fill in the boxes inside the thick -lined frame.
① (1) Student No.
2
0
6
0
2
4
1
2
3
4
(No hyphens)
② Family Situation, etc. (excluding individuals at school) (If the applicant’s spouse has income, add the amount to the
applicant’s income.)
(Relationship)
(2) Applicant
Salary Income
1
15
( S po us e)
2
Non-salary Income
0
(3)
0
,000 yen
20
,000 yen
(4)
(
)
25
,000 yen (5) 30
,000 yen
(6)
(
)
35
,000 yen (7) 40
,000 yen
(
)
45
,000 yen
50
,000 yen
(
)
55
,000 yen
60
,000 yen
(
)
65
,000 yen
70
,000 yen
(
)
75
,000 yen
80
,000 yen
90
,000 yen
(
)
85
,000 yen
(
)
95
,000 yen
100
,000 yen
(
)
105
,000 yen
110
,000 yen
③ Individuals at School
○ Applicant
Commute
115
116
(8)Type of
Scholarship
1
4
(Enter grant-in-aid scholarships only)
(9) Amount Granted 117
7
8
0
for th e Current
,000 yen
Acad emic Yea r
○ Other than the Applicant
Status of Tuition Exemption
(10) Relati on sh ip ( 11) Cat egory ( 12) Category ( 13) Commut e
of Est ab li sh ment
of S ch o o l
(14) 1 s t S emest er
( 15) 2 n d S emest er
(Those at national schools only)
(16) Ann ual Tu iti on
(
)
121
122
123
124
125
126
,000 yen
(
)
129
130
131
132
133
134
,000 yen
(
)
137
138
139
140
141
142
,000 yen
(
)
145
146
147
148
149
150
,000 yen
(
)
153
154
155
156
157
158
,000 yen
(
)
161
162
163
164
165
166
,000 yen
(
)
169
170
171
172
173
174
,000 yen
(
)
177
178
179
180
181
182
,000 yen
(
)
185
186
187
188
189
190
,000 yen
)
193
194
195
196
197
198
,000 yen
(
201
④
0
Single Parent Ho useho ld
⑤
202
Disabilities
(persons)
Care Exp enses
208
⑥
213
,000 yen
(18) Deduction of Tax
Imp os ed on Disaster
Victims
⑦ Number of Family Members
218
(19)
2
(Do not enter)
,000 yen
(17) Lon g-t erm M edical
Living Separat ely
from Primary Earn er
(Do n ot enter)
◎ For Office Use
203
Academic Performance
223
1
220
Self -supported
A
Application Category
224
0
0
221
0
Hous ehold Recei ving
Welfa re B enefits
222
0
Fo r Us e b y St u d ent Sch olars h i p an d Welfare Di vi s i on
1: General (Economic reasons)
5: Reason (Death of primary earner)
6: Reason (Disaster)
227