2018Hirosaki University Graduate School of Humanities and Social Sciences (Master S Program)

International Student – Form A (2018 Admission)

2018 Hirosaki University Graduate School of Humanities and Social Sciences (Master’s Program) Special Screening Program for International Students Application for Academic Requirements

To the Dean of the Hirosaki University Graduate School of Humanities and Social Sciences:

(Roman Letters) Name

Family Name First Name Signature

Date of Birth

Nationality

Address (Postal Code)

Telephone Number

I am submitting the materials necessary to qualify for consideration for application for the Special Screening Program of the Hirosaki University Graduate School of Humanities and Social Sciences

Academic Requirements □ Academic Requirements for Special Selection of Foreign Students 2 Seeking Approval □ Academic Requirements for Special Selection of Foreign Students 3

Name of Faculty Member Date of

Consulted Consultation

* Please check the appropriate square. (see I-2 Academic Requirements for Application) *Please also fill out your education and employment history on the reverse side. Category Year/Month Name of School, School Location and other Relevant Details

Education

Employment History

Academic and Social Activities or Other Relevant Experiences or Activities

Precautions for filling out this form: In the Education section, please list your education since your graduation from high school or other secondary school. Do not list home learning or preparatory school(s). For your undergraduate and graduate school education, please list the respective faculties/schools and departments (majors and programs) In the Employment History section, please list your place(s) of employment, department(s) in which you worked, and your job title(s). In the section for Academic and Social Activities or Other Relevant Experiences or Activities, please provide a summary of any relevant experiences or activities you have had. If you have had none, please write “None”. International Student – Form 1 Please leave the box for Examinee Number blank. Examinee Number

Hirosaki University Graduate School of Humanities and Social Sciences (Master’s Program) Special Admissions Screening Program for International Students Admission Application Form (2018 Admission) Field of Study

Name Roman Letters Family Name Given Name(s) Photograph Mother Tongue (4 cm × 3 cm) Script [*1]

Date of Birth (Year) (Month) (Day) ( years) (Age) Nationality Gender □ Male □ Female

Undergraduate University University

Education Faculty/School

Department

Date of (Year) (Month) (Day) Graduation (Please check the appropriate box) □ Expect to graduate □ Graduated Post-Graduate University University Graduate School Education Graduate School Graduate Course

Date of (Year) (Month) (Day) Completion or □ Expect to complete □ Completed (Please tick the appropriate box) Expected Completion Postal code

Current Address Telephone Fax [*2] E-mail Address Requested Name Supervisor [*3] Check the square □ After admission, in addition my master’s program coursework, I intend to take Japanese if applicable language courses offered by Hirosaki University International Student – Form 1 Please leave the box for Examinee Number blank. Examinee [*1] International students are asked to write their surname followed by their Number given name(s) in the script of their mother tongue. [*2] “Current Address” should be the address at which applicants will receive correspondence until admission is decided. In the event of a change of address, applicants are asked to send prompt notification. [*3] Applicants are asked to obtain the consent of their requested supervisor in advance. International Student – Form 2 (2018 Admission)

Vitae/Resume Please leave the box for Examinee Number blank.

Name Roman Letters Examinee Family Name First Name Number

Mother Tongue

Script [*1]

Year/Month Name of School(s) or Other Details

Elementary Admitted Education School Graduated

Middle Admitted

School Graduated

High Admitted

School Graduated

Under - Admitted [*2] National / Public / Private University Name:

graduate Faculty/School Department/Course

□ Expect [*2] National / Public / Private University Name:

to graduate Faculty/School Department/Course

Graduated

Master’s Admitted [*2] National / Public / Private University Name:

Program/ Faculty/School Department/Course

Master’s □ Expect [*2] National / Public / Private University Name: Course to graduate Faculty/School Department/Course □

Graduated

Research Admitted [*2] National / Public / Private University Name:

Student Faculty/School Department/Course

□ Expect [*2] National / Public / Private University Name:

to graduate Faculty/School Department/Course

Graduated

Year/Month Please check the one that Company Name

applies.

Employment Starting Date

History □ Currently employed Same as Above

□ No longer employed

Starting Date

□ Currently employed Same as Above

Starting Date

□ Currently employed Same as Above

Qualifications / Certifications

Commendations or Criminal Offenses

[*1] International students are asked to write their surname followed by their given name(s) in the script of their mother tongue. [*2] Please circle the type of institution that applies and write the university name in the space to the right. International Student – Form 3 (2018 Admission)

Entrance Examination Fee Remittance Confirmation Form Hirosaki University Graduate School of Humanities and Social Sciences (Master’s Program) Special Screening Program for International Students

 Please pay the entrance examination fee of 30,000 yen by bank transfer.

Roman Letters Nationality Current Country of Residence Family Name First Name Name: Mother Tongue [*1]

[*1] International students are asked to write their surname followed by their given name(s) in the script of their mother tongue. Please remit the entrance examination fee of 30,000 yen to the bank specified below *Precautions  An additional “transfer fee” will be needed for a wire transfer.  In addition, if the transfer is being made from outside Japan, a “Japanese bank transaction fee” will be necessary. Please make sure to notify the bank teller that the transfer fee and Japanese bank transaction fee are to be “paid by sender”. If this is not specified, the financial institution in Japan will automatically deduct the transaction fee from the entrance examination fee, making the payment to Hirosaki University insufficient. In such cases, the entrance examination fee will not be considered paid, so please be aware of this.

(1) Payee Bank Aomori Bank Branch Hirosaki Branch Swift Code AOMBJPJT Name Name Bank Address 9 Oyakata-machi, Hirosaki-shi, Aomori, 036-8191 Japan Account Number 201-1228599 Account Holder’s KEI SATO, PRESIDENT OF HIROSAKI Name UNIVERSITY, NATIONAL UNIVERSITY CORPORATION Account Type Ordinary Account Holder’s Telephone +81 (0) 172-36-2111 Number Account Holder’s Address 1 Bunkyo-cho, Hirosaki-shi, Aomori, 036-8560 Japan

(2) Please fill in the following details: Name of Relation to Applicant Person Making Remittance International Student – Form 3 (2018 Admission)

Bank Making Account Number Branch Name Transfer

Date of (Year) (Month) (Day) Transfer International Student – Form 4 (2018 Admission)

Research History or Performance Report for Specialized Training and English Language Proficiency Report Name Roman Letters Examinee Family Name First Name Number

Mother Tongue Please leave the box for Examinee Number blank. Script [*1]

[*1] International students are asked to write their surname followed by their given name(s) in the script of their mother tongue. Summary of Past Research or Results of Specialized Training

Titles of Academic Papers, Research Dates of Publication Names of Publisher, Journal, or Academic Names of Co-authors

Reports, Presentations, Patents, etc. or Presentation Society or Co-presenters

English TOEIC score ( ), TOEFL score ( ), IELTS score ( ) Language *Please write the results of any of the above-mentioned English language proficiency tests and affix a photocopy Proficiency of the official score notification or certificate. (Note) Please affix separate offprints or photocopies of academic papers, etc. Academic papers currently in the process of submission will not be considered. However, papers already accepted for publication will be accepted if the manuscript (photocopy) and proof of acceptance are provided. International Student – Form 5 (2018 Admission) Please

leave the box for Examinee Number blank. Examinee Number Research Plan

Name Roman Letters

Family Name First Name Mother Tongue Script [*1]

[*1] International students are asked to write their surname followed by their given name(s) in the script of their mother tongue. International Student – Form 6 (2018 Admission)

Research Topic Title

L e t t e r

A c c e p t a n c e

F r o m

R e quested Research Supervisor Hirosaki University Graduate School of Humanities and Social Sciences (Master’s Program) Special Screening for International Students

Title: Name :

Name of Applicant: Relation to Applicant:

(Roman Letters)

Family Name First Name

I consent to supervise the applicant upon the applicant’s acceptance into the Master’s program.

Signature:

● Precautions for filling out this Letter of Acceptance.

 Relation to applicant: For example, supervisor (university, graduate school, etc.), research collaborator, etc. Please make sure to affix documents showing your correspondence with the applicant (copies of letters, e-mails, etc.) to this Letter of Acceptance. The requested supervisors of applicants are asked to submit this form themselves directly to the Entrance Examination Section of Hirosaki University. International Student – Form 7 (2018 Admission) Please leave the box for Examinee Number blank. Examinee Number Address Labels

Name (Roman Letters):

Family Name First Name

(Mother Tongue)*: [*] International students are asked to write their surname followed by their given name(s) in the script of their mother tongue.

These will be used when mailing your Notification of Examination Results, admission procedure documents and for other correspondence. Please accurately fill in your postal code, address and name throughout this entire form and submit it together with the other application materials. In the event of a change of address or other details after submission of application, please promptly inform the Academic Affairs Group, Faculty of Humanities and Social Sciences. Postal Code

Address

*Please leave this field blank. *

Postal Code

Address

*Please leave this field blank. *