THE UNIVERSITY OF TOKYO
DIVISION OF ENVIRONMENTAL STUDIES
GRADUATE PROGRAM IN SUSTAINABILITY SCIENCE –GLOBAL LEADERSHIP INITIATIVE
APPLICATION FOR ADMISSION TO GRADUATE PROGRAM IN SUSTAINABILITY SCIENCE
–GLOBAL LEADERSHIP INITIATIVE
Academic Year 2016 (September 2016 Enrollment)
Type or write in block letters.
Photo
(3cm × 4 cm)
1. Name:
Family name
First name
2. Date of Birth:
Middle name(s)
( )Mr. ( )Ms.
3. Age (as of coming April):
（month/day/year）
4. Nationality:
5. Marital status: ( ) Single ( ) Married
6. Present status, and the name of your university or employer:
7. Present mailing address:
8. E-mail address:
9. Cell/Mobile Phone No. :
10. Fixed Phone No. :
11. Fax No. :
12. Permanent address, if different:
13. Place where you will do your Skype oral examination (interview) and the time zone:
Place:
UTC/GMT Time Zone:
(Examples: Tokyo = + 9 hrs
14. Degree objective:
( ) Master of Sustainability Science
( ) Ph.D. in Sustainability Science
1/4
hrs
Costa Rica = - 6 hrs)
15. Academic Background:
Sample
Elementary
Education
Or
Name of School and
Location
Year and Month
of
Entrance/Com
pletion
Period
of
attending
(name)
Kashiwa E.S.
(location)
Chiba, Japan
(name)
(from)
April 1985
(to)
March 1991
(from)
6 Years
And
0 Month
Category of
earned
degree/diplo
ma
General
Yrs.
(location)
(to)
And
Elementary
School
Secondary
Education
Major
Mos.
(name)
(from)
Yrs.
(location)
(to)
(name)
(from)
And
Or
Mos.
Lower and
Upper
Secondary
School
Yrs.
(location)
(to)
And
Mos.
Higher
Education
(name: Department,
Faculty, University)
Or
Undergrad
uate Level
(location)
Graduate
Level
(from)
Yrs.
(to)
And
Mos.
(name: Department,
Graduate School,
University)
(from)
Yrs.
(to)
And
(location)
Others
(name)
Mos.
(from)
Yrs.
(location)
(to)
And
Mos.
Total of schoolings
Yrs.
16. Which financial aid will you apply for through the University of Tokyo?
□MEXT
□ ADB
2/4
Class average
and/or GPA
17. Indicate your three choices for your prospective supervisor from the list of faculty members of GPSS-GLI
(http://www.sustainability.k.u-tokyo.ac.jp/members/).
Name
Title
Institution
(1)
(2)
(3)
18. Professional experience, if any. List names of employers, job titles and duration, starting with the most
recent employment.
Employer
Title
Duration
(1)
(2)
(3)
(4)
(5)
19. Will you apply/have you applied for other universities? If so, indicate the name of the schools:
Department,
School,
University
(1)
(2)
(3)
20. Do you understand that concurrent application for MEXT scholarship through different universities’
recommendation is prohibited?
(
) Yes
21. Would you like to apply for the exemption from the submission of a TOEFL score?
( ) Yes
( ) I have graduated or will graduate from a university or a graduate school in Australia, Canada, New
Zealand, the United Kingdom, or the United States
( ) I have graduated or will graduate from a university or a graduate school where English is the
official language
※Official document issued by the university to prove it must be enclosed.
( ) No
( ) TOEFL Test Taker Score Report (Examinee Score Report) or ILELTS Test Report Form is
attached in the application documents.
( ) TOEFL Test Taker Score Report (Examinee Score Report) or ILELTS Test Report Form
is sent by the deadline in a separated envelope.
3/4
22. For our information, please inform us how you got to know our program. Please check X.
(1) GPSS website
(
(3) Your supervisor (
(5) Your university (
(7) Others (
)
)
)
(2) Other website, in details (
(4) Your friends ( )
(6) Local media, such as newspaper
)
(
)
)
I hereby confirm that information I’ve given in this application form is complete and accurate.
Signature:
Date:
This completed application, official certified of diploma, official transcript from each college-level institution previously attended or
presently attending, and two confidential sealed letters of recommendation with signature across the seal should be enclosed in an
envelope and be forwarded to:
International Liaison Office
The University of Tokyo
Chiba, JAPAN
4/4