Summer APU Gateway Program
Application Documents
Required Documents for All Applicants
1. Summer APU Gateway Program Application Form
2. Proof of Application Fee payment
3. Passport Copy
4. Two passport-sized photos (4cm X 3cm)
5. Certificate of University Enrollment
6. Official Academic Transcripts (if not using Grade Point Average (GPA), attach a scale sheet)
If you are currently not enrolled at a university, the following additional documents are required:
Recommendation letter (s) and/or copy of acceptance letter from the college/university you are scheduled to
1.
enter
Evidence of 12 years of elementary and secondary education to prove that this has been or will be achieved by
2.
the time of program commencement. (e.g. High School Diploma, School Leaving Certificate, Certificate of
Prospective Graduation/ completion etc.)
Language Proficiency Test Scores
TOEFL (ITP/iBT/ PBT)
TOEIC
IELTS
Language Proficiency Forms
1.
Japanese Evaluation Sheet
2.
Japanese Background Questionnaire
Application Categories
Are you a native speaker of English?
Do you have Japanese study background?
+
only
Do you have Japanese study background?
+
+
+
Privacy Protection Policy
The Ritsumeikan Trust (hereby the “School”) strictly obeys the rule and regulations in the handling of personal
information of students and education research personnel. In addition, the School has established its own
rules and system to protect all personal information of related individuals.
Usage of Personal Information
Personal information of all applicants (inclusive of guardians) of Ritsumeikan University/ Ritsumeikan Asia
Pacific University is used for the process of enrollment after the release of results, and for tabulation of
statistical analysis of the school information.
For successful applicants, personal information (about lodging, life-related information, etc) will be provided at
the discretion of the respective universities for preparation of student life in the school.
For individuals who have completed the necessary enrollment procedures, the provided information will be
used as student information.
For information about Personal Information Privacy Policy, please check the homepage http://www.apu.ac.jp.
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FOR UNIVERSITY USE
大学使用欄
受験番号
Summer APU Gateway Program Application Form
1. Applicant Information
1. Family Name in English:
2. Given Name(s) in English:
Please affix a photograph
Name in Chinese Characters (if applicable):
(4cm X 3cm),
3. Date of Birth:
Year
4. Gender:
Male
Month
Date
taken within the last 3
Female
5. Nationality:
6. Native Language:
7. Email:
(Please write this clearly, as this e-mail will be used as the primary contact.)
8. Current Address:
City / State
Phone: Country Code(
Country
)
Mobile: Country Code(
Postal Code
)
9. Mailing Address（if different from above）:
City / State
Country
Phone: Country Code(
)
Mobile: Country Code(
Postal Code
)
(As important documents will be sent to this mailing address, fill in this information accurately.)
10. Emergency Contact Person:
Relationship to you:
Emergency Contact Address:
City / State
Phone: Country Code(
Country
)
Mobile: Country Code(
Email:
11. Home University:
12. Major :
13. University Address:
City / State
Country
Postal Code
3
Postal Code
)
2. Education History
1. Have you completed 12 years of official education?
Yes
No
expected completion date:
Total years of Education
Primary school
years
Junior high school
years
High school
years
University level
Others (
years
)
years
2. Type of School (Degree you will receive upon completion)
University (Bachelors Degree)
Graduate School (Master’s Degree)
Junior College (Degree Course, Associate Bachelor Degree)
Vocational/Technical College (Certificate Course, Vocational School, etc)
Other (Please explain in detail):
3. Language you were taught in:
4. Title of Degree:
Obtained
Scheduled to Obtain Date:
y
m
d
3. Optional Academic Course
You have the option of registering one academic course in addition to the Japanese Language course.
Do you wish to take an extra academic course?
Yes
No
＊
There is an additional charge of JPY 45,000 per 1 credit.
Most APU lecture courses are worth 2 credits (JPY 90,000).
＊
Course registration for this optional academic course will be conducted online at a later date. A link to the course registration form
will only be sent to students who indicate their interests for taking optional academic course here.
＊
The Summer APU Gateway Program Japanese Language Course is a 6 credit language subject which meets 12 times a week. If
you decide to take an optional academic course, you will have 2 additional classes, making a total of fourteen 95-minute classes
per week.
4. Self-report of Health Condition & Special Needs
We ask for your cooperation in informing us regarding any physical or health concerns you may have. Please write as
accurately as possible so that we can try to provide appropriate support as necessary. If you have any disability or require
special needs due to a medical condition and would like to request for academic support at APU, please make sure to
attach to this form an official proof document or letter issued by your home university regarding the services
which your home university provides you with. Please note that the information you provide may be shared with the
APU Health Clinic or the home university if necessary.
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1.
Do you have any concerns about your physical or health condition? (Please check
)
Yes (If “yes”, Please answer questions 2 to 4 below.)
Not in particular
2.
Please feel free to write any physical or health concerns you may have. Please include anything you have been
diagnosed with such as a physical disability (e.g., visual or hearing impairment), learning disability (e.g., dyslexia),
mental disorder (e.g., panic disorder) or other medical conditions (e.g., hyperventilation syndrome, eating disorder) .
Please also let us know if you have any allergies we should be aware of.
3.
Please do let us know if you have any special needs for particular services or support. This might include extra
equipment, special consideration to complete your exam etc.
4.
Please specify the services your home university arranges for you.
＊
Any concerns addressed here will not affect admission decisions.
＊
Successful applicants will be asked to submit a Medical Consent form signed by the university health center or a physician.
5. Application Fees Payment
A non-refundable JPY 11,750 application fee is compulsory for the application.
Applications will not be evaluated without
the application fee. Payment must be made by bank transfer; cash payments will not be accepted.
Payment Date:
Payer's Name:
* All telegraph transfer fees are to be paid by the applicant.
6. Pledge and Signature
I hereby apply for admission to the “Summer APU Gateway Program" (hereinafter referred to as "Program") according to the following
terms:
1. The application documents shall not contain any falsified information.
2. I understand that submitted documents for this application become the property of the Ritsumeikan Asia Pacific University and will not
be returned to me.
3. I understand that the program fee includes the costs for application, tuition, activities, accommodation, and bank transfer fees. I will
pay any expenses that are not included in the program fee. I must pay the program fee to the bank account specified by Ritsumeikan
Asia Pacific University by the designated deadline.
4. If I withdraw from the program for my own reasons, I understand that a refund will be provided according to the following.
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・
Screening Fees (required for all applicants): Non-refundable
・
Registration Fees: Non-refundable
・
Program Fees (tuition and activity fee): Will refund if a student withdraws by April 30 Japan time (if the deadline falls on a
Saturday, Sunday or a National Holiday, the University must be informed of the withdrawal on a working day before the
deadline).
Housing Fees: Will refund Housing Fees except for the moving-in fee (JPY 16,000) if a student withdraws by April 30 Japan
・
time (if the deadline falls on a Saturday, Sunday or a National Holiday, the University must be informed of the withdrawal on a
working day before the deadline).
Bank transfer fees will be deducted from the refunds. Refunds will be returned to the student by APU in a timely manner.
5. If Ritsumeikan Asia Pacific University cancels the Program for its own reasons or due to natural disaster, strike, contagious disease,
change in political situation, war, terrorism, or any other unavoidable circumstances, I understand that a refund will be provided
according to the following. If the refund is to be made by overseas remittance, any processing fees will be deducted from the repayment
sum noted below.
a. If the Program is canceled before the date of commencement, the program fee will be refunded.
b. If the Program is canceled after the date of commencement, the tuition and activities portion of the program fee for the remaining
program period will be refunded. However, the costs for application, APU housing and bank transfer will not be refunded.
6. I am liable for any debt incurred while in Japan.
7. I will not hold Ritsumeikan Asia Pacific University responsible, monetarily or otherwise, should I cause an accident or become ill by my
own negligence or in circumstances that are out of Ritsumeikan Asia Pacific University’s control.
8. I will bear sole responsibility for dealing with matters such as theft or damage of my personal items, traffic accidents, criminal cases, or
other matters that may arise that are outside of Ritsumeikan Asia Pacific University’s control.
9. If I cause any serious damage to Ritsumeikan Asia Pacific University, deliberately or by gross negligence, I am liable to compensate
for the damages.
10. If I should violate any of the matters in the Pledge, Ritsumeikan Asia Pacific University may direct me to withdraw from the program
or return to my home country.
11. I understand the outline and aim of the Program and I will attend all scheduled Japanese classes and activities.
12. For the duration of the Program, I will conduct myself with the awareness that I am a Program participant.
13. For the duration of the Program, I will follow the instructions given to me by the Ritsumeikan Asia Pacific University staff and faculty
and will not violate any public policy, law, or regulation of Japan.
14. I will abide by the rules and regulations of the residential facility.
15. Staying healthy for the duration of the Program will be my own responsibility, and if I am injured or become ill during the Program
period I am responsible for undergoing any medical treatment that may be required.
16. I will not operate or purchase a bicycle, car, motorbike, or any other vehicle during the program period.
17. I understand that the participants of this program are required to purchase overseas health and travel insurance before departure.
Name
Date
Signature
We strongly recommend you keep a copy of all submitted materials for your records.
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Application Essay
Please write the reason/s why you wish to study in APU.
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Housing Application
1. Housing Regulations and Fees
Summer APU Gateway students are guaranteed university arranged housing either on or off campus depending on the
availability. Total housing fees are to be paid prior to arrival and the housing invoice will be sent with the Acceptance
Package.
Approximate Housing fees:
Moving-in fee (Non-refundable)
JPY 16,000
Rent for 2 months
JPY 78,000
*Moving-in fee and rent are subject to change.
Note:
① Once paid, the Moving-in fee will not be refunded under any circumstances.
② Resident will be billed separately for any damages caused by the renter’s fault.
2. Room Types
There are individual rooms and share-typed rooms.
Please check one of the following:
I wish to reside in a share-typed room.
I wish to reside in an individual room.
Either is fine.
Please keep in mind that this is only a survey and you may not be able to reside in the room you wish depending
on the availability.
I agree with the above conditions.
Date：
Signature：
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English Proficiency Test Scores
If you have taken any English proficiency tests in the list below, please fill in your test details and attach the
score report with your application.
Test Name
Test Date (Year, Month)
TOEFL (iBT/ PBT/ITP)
y
m
TOEIC
y
m
IELTS
y
m
Test Score
(TOEFL Registration ID:
(TOEIC Registration ID:
(IELTS Test Report Form Number:
Please attach the score copy
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)
)
)
Japanese Proficiency Evaluation
Instructions for the applicant – Complete Part 1 and hand this form to your Japanese teacher. If possible, the teacher
should have taught you for at least a year or more. Please ask him/her to return this form to you in a sealed envelope.
PART 1
To be completed by applicant
Applicant’s name:
Instructions for the evaluator – Complete Part 2. You should be an individual in the field of Japanese language education.
Please assess the language proficiency of the applicant objectively by checking the below chart, and completing the
comments in the provided space in view of his/ her ability for university classes. Please enclose this form in a sealed
envelope, and write your signature over the sealed flap, then return the sealed envelope to the student.
PART 2
To be completed by evaluator
Name:
Position:
Name of Organization/ Institution:
Address:
Contact Number:
Time period that you have taught the applicant: :
Email:
y
m
～
y
m
What textbooks will he/she has completed before beginning the Summer APU Gateway Program?
What are his/her standing in your course(s)? (Please give a percentage, mark letter grade, or other indication of
performance.)
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Please indicate the approximate number of kanji he/she;
can recognize
can produce
Please evaluate him/her in comparison with other students you have taught as a comparable level of training. Please
check the appropriate boxes to indicate his/her Japanese language proficiency.
Excellent
Good
Average
Below Average
Speaking
Listening
Writing
Reading
This Program offers an intensive Japanese language course for 8 weeks plus optional academic courses in English. Can
he/she be recommended for such a program?
Highly recommended
Recommended
Not recommended
Please write your comments about his/her language abilities.
Date:
Signature:
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Japanese Background Questionnaire
Applicant’s name:
Japanese Language Course Completed
List the following information for each formal Japanese course you have completed. Please also let us know if you are
currently enrolled in a Japanese language course.
Example:
Class Name
Class Hours
From/To
Japanese101
100
Sep2009/April2010
Total Hours:
Total Months:
Institution
Ritsumeikan University
Please list the textbooks you have used, including the chapters or sections of each textbook you have completed.
(You can continue on a separate sheet if necessary.)
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Please check the appropriate boxes to indicate your Japanese language proficiency.
Excellent
Good
Average
Below Average
Speaking
Listening
Writing
Reading
Please indicate the approximate number of kanji you;
can recognize
can produce
Japanese Language Proficiency Test（日本語能力試験）
If you have taken this examination, please attach a copy of the test result report(s), and mark your level below.
Level N1 (Score:
)
Level N2 (Score:
)
Level N3 (Score:
)
Level N4 (Score:
)
Level N5 (Score:
)
Please attach the score copy
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If you have any other information relevant to your Japanese language ability which you think we should know about, please
comment here.
Essay In Japanese
Please write an essay introducing yourself in Japanese.
Note: This shall not affect the outcome of the result of your application for the Summer APU Gateway Program.
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