Application for admission

Application No. _______________

APPLICATION FOR ADMISSION TO THE INTERNATIONAL EDUCATIONAL PROGRAM OF “ADVANCED GRADUATE SCHOOL OF CHEMISTRY AND MATERIALS SCIENCE (AGS)” IMPORTANT NOTE: § Attach all the necessary documents specified in this form. § Unclear or incomplete application without proper explanation will not be considered.
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Male Female

Single Married

(1) Name

(first name - middle name – surname)

(2) Nationality (3) Date of birth (4) Age as of April 1, 2016

(5) Present address

Phone Fax E-mail

(6) Permanent address

Phone Fax E-mail

(7) Write down the name of a professor that you want to be considered for supervisor

(i) Professor:

(8) Please choose the starting date

1. April, 2016 　 2. October, 2016

(9) Educational background (you must submit together with this application a copy of your academic transcripts (complete or up to the time of your application if your study is still in progress). If the rank is not indicated therein, an official ranking certificate is necessary. The certificate should indicate that you are among the top 5% or etc. in your graduating class. All documents submitted with this application must be attested by the issuing university.)

	Institution, Country	Officially required years for graduation	Yr and Mo of entrance and completion	Period of schooling you have attended	GPA	Rank in class (rank/total students)	Major subject	Diploma or degree awarded
Elementary education Elementary school		yrs	from / to /	yrs
Lower secondary school		yrs	from / to /	yrs
Upper secondary school		yrs	from / to /	yrs
Higher education Undergraduate level		yrs	from / to /	yrs
Graduate level		yrs	from / to /	yrs

(10) Employment record (begin with the most recent employment)

Organization, city, country	Period of employment (month/year)	Position	Type of work
	from / to /
	from / to /
	from / to /

(11) Write down the title of your master’s thesis and attach its summary (unspecified format, approximately two A4-sized pages). Those expecting to be awarded a master’s degree should provide an abstract of the research conducted over the course of their master’s program (up to 500 words) or other equivalent materials

(12) Have you been awarded any scholarship, grant, award or prize in the past? If yes, please provide details.

Scholarship, grant, award, prize	Period	Explain briefly about the scholarship, etc.

(13) Have you ever stayed in Japan for studying or for working? If yes, please provide details.

Date	Organization, city	Purpose
from / to /
from / to /

(14) Name of references (at least two) and their email addresses. You should request for the recommendation letters yourself.

(i) E-mail:
(ii) E-mail:

(15) How did you hear about our program?

I understand that withholding pertinent information requested in this application form or giving false information will make me ineligible for admission or liable for dismissal.

Signature Date submitted

Send the completed application form together with the supporting documents to

AGS Office at the Frontier Chemistry Center

Graduate School of Chemical Sciences and Engineering,

Hokkaido University

Sapporo 060-8628, Japan

Fax: [phone]

E-mail: [e-mail]

Shipping check list:

1. Admission Application (prescribed form)

2. Two recommendation letters

3. Summary of your master’s thesis or an abstract of your research achievements

4. List of publications and copies of key research papers　(if any)

5. An academic transcript from both undergraduate and graduate schools 　　　　　　　　

6. Official certificates of degrees (Both Bachelor’s Degree and Master’s Degree)

7. A certificate for English qualification

8. A copy of your passport

※All documents should be written in English or Japanese Language

Дата добавления: 2015-11-04