Summer APU Gateway Program
Application Documents
Compulsory Documents
1. Summer APU Gateway Program Application Form
2. Application Fees
3. Passport Copy
4. Two passport-sized photographs (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)/
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. Home University:
Please affix a photograph
2. Name of Department:
3. University Address:
(4cm X 3cm),
City / State
Country
Postal Code
taken within the last 3 months .
4. Family Name:
5. Given Names:
Name in Chinese Characters (if applicable):
6. Date of Birth:
7. Gender:
□
Year
Male
Month
□
Date
Female
8. Nationality:
9. Native Language:
10. Email:
11. Current Address:
City / State
Phone: Country Code(
Country
)
Mobile: Country Code(
Postal Code
)
12. Mailing Address（if different from above）:
City / State
Country
Phone: Country Code(
)
Mobile: Country Code(
13. Emergency Contact Person:
Postal Code
)
Relationship to you:
Emergency Contact Address:
City / State
Phone: Country Code(
Country
)
Mobile: Country Code(
3
Postal Code
)
2. Education History
□ Yes
1. Have you completed 12 years of official education?
□ No
expected completion date:
Total years of Education
Primary school
years
Junior high school
years
High school
years
University level
years
Others (
)
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 43,000 per 1 credit.
＊
Course registration for this optional academic course will be conducted online at a later date. A link to the course registration form
Most APU lecture courses are worth 2 credits (JPY 86,000).
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. Others
Do you have any concerns that you feel we should be aware of (i.e. academic, learning, mobility, dietary etc.)?
＊
Any concerns addressed here will not affect admission decisions.
＊
All successful applicants will be asked to submit a Special Needs form and a Medical Consent form signed by the university health
center or a physician.
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5. Application Fees
A non-refundable JPY 11,750 application fee is compulsory for the application. Payment must be made by bank transfer;
cash payments will not be accepted.
Payment Date:
Payer's Name:
* Applications will not be evaluated without the application fee.
* All telegraph transfer fees are to be paid by the applicant.
FOR UNIVERSITY USE 大学使用欄
願書受付日
選考手数料受付日
／
／
／
／
／
／
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Application Essay
Please write the reason/s why you wish to study in APU.
V. Declaration and Signature
I understand that the University may vary or cancel any decision if any incorrect or incomplete information is
given; submitted documents for this application become the property of the University and will not be returned
to me.
I hereby declare that all information provided are true and correct.
Date:
Applicant’s Signature:
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AP House Application
1. AP House Regulations and Fees
Summer APU Gateway students are guaranteed rooms at AP House on campus and in principle, are required to live at
AP House.
Total housing fees are to be paid prior to arrival and the AP House invoice will be sent with the Acceptance
Package.
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.
① Once paid, the Moving-in fee will not be refunded under any circumstances.
Note:
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 in AP House.
The AP House fee for both types is the same.
Please check one of the following:
□
I wish to reside in a share-typed room.
□
I wish to reside in an individual room (Please write down the reason in the space below).
□
Either is fine
（Reasons for applying for an individual room）
Please keep in mind that this is only a survey and you may not be able to reside in the room you wish.
I agree with the above conditions.
Date：
Signature：
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Details of individual room
Room Area: 13 ㎡
Equipped items: Desk, chair, bookshelf, lighting, telephone, TV aerial socket, closet, bed, refrigerator,
shelves, air-conditioner / heater, basin, toilet, shoe holder and VDSL Modem.
Common area: Kitchen, Shower room
Details of share-typed room
Room Area: 13.5 ㎡
Equipped items: Desk, chair, bookshelf, lighting, telephone, TV aerial socket, closet, bed, refrigerator,
shelves, air-conditioner / heater, basin*, toilet*, shoe holder and VDSL Modem.
Common area: Kitchen, Shower room, Toilet and Basin
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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 (Month, Year)
TOEFL (iBT/ PBT/ITP) y
IELTS
y
Test Score
m
(TOEFL Registration ID:
m
(IELTS Test Report Form Number:
Please attach the score copy
9
)
)
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:
Email:
Time period that you have taught the applicant: :
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
Institution
Ritsumeikan University
the institution is
Total Hours:
Total Months:
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
If you have any other information relevant to your Japanese language ability which you think we should know about,
please comment here.
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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.
Date:
Signature:
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