Ph. D.

Program 2008 Fall Enrollment (IGP-I) For reference use

Graduate School of Science and Technology
Keio University

Please check the appropriate boxes below, and enclose this form together with all application
documents.
The application deadline is December 15, 2007 (for enrollment in September 2008).

Application Check List for Ph.D. Program application:

□ Application forms (prescribed forms No.1-No.4)

□ Financial statement (prescribed form)

□ Research plan (prescribed form, to be completed in Japanese or English)

□ Two letters of recommendation (prescribed form, in Japanese or English)

□ Official academic transcripts for undergraduate and master’s courses (in English or Japanese -no photocopies)

□ Certificate of graduation from a university (in English or Japanese -no photocopies)

□ Certificate of graduation or expected graduation from a graduate school (in English or Japanese -no photocopies)

□ Summary and supplementary information of academic transcripts for undergraduate courses (the registrar's office

of the University where the applicant completed his undergraduate studies must fill out the transcript request

form).

□ Application fee payment

Application fee 10,000 Japanese yen

Please enclose evidence of payment of the application fee when submitting your application. Those living overseas

should make the payment via international postal money orders.

Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use
Graduate School of Science and Technology
Keio University
All of above should be sent together in a single package to Keio University

Note:
A) Please check the accuracy of all materials before mailing. Incomplete application will not be processed.

B) Only official copies of transcripts will be processed.

C) All official documents must be submitted in English. Non-English original documents must be accompanied

by certified translations in English or Japanese translations certified by a notary public or the school issuing

the original document.

D) Write your name as it appears on your passport or on your birth certificate.

E) Complete the section on contact information: include e-mail address, emergency contact phone number, and

fax number.

F) If you are changing your address next year, please include the address where you would like the screening

result to be sent.

G) Do not open the sealed letters of recommendation.

Application documents must be mailed to the address given below.

Admissions Office
Graduate School of Science and Technology, Keio University
3-14-1 Hiyoshi, Kohoku-ku, Yokohama, Kanagawa 223-8522
JAPAN

Application Period: November 1 -- December 15, 2007

Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use APPLICATION
FORM-1
Graduate School of Science and Technology
Keio University
The application form should be typewritten if possible, or neatly handwritten in block letters. Attach your photo
taken within the
Personal Information last 3
months.
Write your name
and
Name in block capitals: , nationality in block
Legal family name (surname) First name (given name) Middle name letters on the back
of
the photo.
Name in native language: ,
Legal family name (surname) First name (given name) Middle name

Nationality: Date of birth:

Month Day Year

Sex: □ Male □ Female Marital Status: □ Single □ Married Current Occupation:

Address:

Postal code Country

Phone: [ ] Fax: [ ]
Country code Country code

E-mail address:

Emergency Contact

Name: Relationship:

Phone: [ ] Fax: [ ]
Country code Country code

(Only for applicants changing address next year) Send screening results to:

UNDERGRADUATE EDUCATION

Name of Institution:

Name of Department: Major Field:

Entrance Date: Graduation Date:

Month Year Month Year

Degree awarded:

Title of Graduation Thesis:

Honors: Class rank:

GRADUATE EDUCATION

Name of Institution:
Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use
Graduate School of Science and Technology
Keio University
Name of Department: Major Field:

Entrance Date: Graduation Date:

Month Year Month Year

Degree awarded:

Title of Master Thesis:

APPLICATION
Honors: Class rank: FORM-2

Please check one of the following schools you wish to enter at Keio University:

□ School of Fundamental Science and Technology □ School of Integrated Design Engineering

□ School of Science for Open and Environmental Systems

List the names of faculty members at Keio whom you are considering as your research advisor. Please list in order of

preference and briefly explain why. Use staff search on our website.

1. Name

Reason

Contact by e-mail □ more than 10 times □ more than 5 times □ 1-5 times □ none

2. Name

Reason

Contact by e-mail □ more than 10 times □ more than 5 times □ 1-5 times □ none

3. Name

Reason

Contact by e-mail □ more than 10 times □ more than 5 times □ 1-5 times □ none

List names and addresses of persons from whom you have requested letters of recommendation:

Name Address Relationship

Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use
Graduate School of Science and Technology
Keio University
Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use
Graduate School of Science and Technology APPLICATION
FORM-3
Keio University
Grade point average (GPA): Please calculate your GPA and indicate the results below. To calculate your GPA, multiply the

point value of your grade by the total number of units and divide the total grade points by the total units. Grade point

values are A or A+ = 4.0, A- = 3.7, B + = 3.3, B = 3.0, B- = 2.7, C+ = 2.3, C = 2.0, C- = 1.7, D+ = 1.3, D = 1.0, D- = 0.7,

F = 0.0

Undergraduate GPA:

Cumulative (overall): First two years: Last two years:

Master’s Course GPA:

Cumulative (overall):

Have you ever studied outside your country? □ Yes □ No

If yes, list the names and locations of the institutions, and any degrees attained:

Language Proficiency

Please indicate your language level.

English

Reading □Good □Fair □Poor

Writing □Good □Fair □Poor

Listening □Good □Fair □Poor

Speaking □Good □Fair □Poor

Japanese

Reading □Good □Fair □Poor □No Background

Writing □Good □Fair □Poor □No Background

Listening □Good □Fair □Poor □No Background

Speaking □Good □Fair □Poor □No Background

Others ( )

Reading □Good □Fair □Poor

Writing □Good □Fair □Poor

Listening □Good □Fair □Poor

Speaking □Good □Fair □Poor

What is your native language?

 APPLICATION
Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use FORM-4

Graduate School of Science and Technology

Keio University
List positions you have held (not as a student), such as professional experiences, laboratory work, or occupations. Include

military service and any teaching experience. Provide the names of your employers, the dates of the employment or work

period, and whether the positions were paid or voluntary.

Period Employer / organization Job title Paid / voluntary

List articles, books, or other material published, and any inventions patented:

List academic honors, prizes, fellowships, scholarships, traineeships, or honorary scholarships you have received, or honor

societies to which you have been elected:

Declaration:

I certify that the information contained in this application, in the statement of purpose, and in the supporting documents

is complete and accurate, and I understand that submission of inaccurate information may be sufficient cause for denial

of admission or termination of enrollment. I also agree to waive my right to read letters of recommendation and other

supporting documents.

Signature Date
 FINANCIAL STATEMENT
Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use
Graduate School of Science and Technology
Keio University
Financial Statement

Name:
Legal family name (surname) First name (given name) Middle name

Present occupation:

Monthly income: Japanese Yen

(1US$ = 125 Japanese Yen)

Spouse’s full name and occupation:

Monthly income: Japanese Yen

(1US$ = 125 Japanese Yen)

Please select how you are planning to afford the payment for the graduate studies.

□ 1. I will apply for scholarship and will not enroll without scholarship.

□ 2. I wish to enroll even when the scholarship is not awarded.

□ 3. I have financial support from other sources.

For applicants who checked 2 or 3, please specify how you plan to cover tuition fees and living expenses in Japan.

(1US$ = 125 Japanese Yen)

□ Support from parents (or guardian): Japanese Yen / year

□ Support from relatives: Japanese Yen / year

□ Support from sponsor: Japanese Yen / year

□ Student’s personal resources: Japanese Yen / year

□ Scholarships:

Name of Scholarship □Awarded □Applying

Japanese Yen / year

Name of Scholarship □Awarded □Applying

Japanese Yen / year

□ Other resources, please list all: Japanese Yen / year

Total financial resources: Japanese Yen / year

Note:
Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use
Graduate School of Science and Technology
Keio University
If you are going to apply for Monbukagakusho (Japanese Government) Scholarship Program, please download
the Scholarship Application Form from our admissions webpage and submit it together with other application
documents. Please read the conditions for scholarship carefully before applying.
 RESEARCH PLAN
Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use
Graduate School of Science and Technology
Keio University
Research Plan for Ph.D. Program

Name:

Legal family name (surname) First name (given name) Middle name

State your purpose for applying to graduate study, your particular area of specialization within a major field, your professional plans, and
any additional information that may assist the Admissions Committee in evaluating your application preparation and aptitude for graduate
study at Keio University. This may include information regarding characteristics that will enable you to complete the graduate degree
program. Please use the space below for your response or attach additional page or pages, if needed.

Signature Date
Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use
TRANSCRIPT REQUEST
Graduate School of Science and Technology FORM
Keio University

To be completed by the applicant:

Legal family name (surname) First name (given name) Middle name

I hereby authorize the release of my academic record to the Graduate School of Science and Technology at Keio University.

Signature of the applicant Date (yyyy/month/date)

To be completed by the Registrar:

The above person is applying to the Graduate School of Science and Technology at Keio University. Please fill out the required information
and enclose this form together with an official transcript in an envelope. Please seal the envelope, sign across the envelope seal, and return
it to the applicant so it can be included with the application documents. Should you have any questions, contact
ao_at_inquiry@info.keio.ac.jp

What is the language of instruction at your school?

___________________________________________

Applicant’s cumulative grade point average

(Grade point values are A or A+=4.0, A-=3.7, B+=3.3, B=3.0, B-
Degrees (to be) awarded
=2.7, C+=2.3, C=2.0, C-=1.7, D+=1.3, D=1.0, D-=0.7, F=0.0)

Applicant’s cumulative rank in class Class size

Highest possible grade in your school Lowest possible grade in your school

Signature of the Registrar Date (yyyy/month/date)

Official school seal or stamp

___________________________________________
Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use LETTER OF
RECOMMENDATION
Graduate School of Science and Technology
Keio University
Letter of Recommendation

Applicant: Be sure to inform your recommenders of the application deadline.

Name:
Legal family name (surname) First name (given name) Middle name

THIS PART TO BE COMPLETED BY THE RECOMMENDER

To the Recommender: The person named above is applying for admission to the Graduate School at Keio University. We would
appreciate your personal impressions of the applicant’s intellectual ability, aptitude in research, and/or professional skills. Please comment
on the applicant’s character, the quality of previous work, and the promise of productive scholarship in Japanese or English. If applicable,
please include any known obstacles the applicant may have overcome to attain her or his educational goals (e.g., financial, social, cultural,
educational, or other disadvantages). Please enclose this form in an envelope, seal it, sign it across the seal, and return it to the
applicant.

Please rate this applicant in each category.

Academic Performance □Below Average □Average □Good □Outstanding □Truly Exceptional □Inadequate to Observe

Intellectual Potential □Below Average □Average □Good □Outstanding □Truly Exceptional □Inadequate to Observe

Motivation for Graduate Study □Below Average □Average □Good □Outstanding □Truly Exceptional □Inadequate to Observe

Recommender’s name (please print):

Position or title: School or company:

Address:
Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use
Graduate School of Science and Technology
Keio University

Signature: Date:
Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use LETTER OF
RECOMMENDATION
Graduate School of Science and Technology
Keio University
Letter of Recommendation

Applicant: Be sure to inform your recommenders of the application deadline.

Name:
Legal family name (surname) First name (given name) Middle name

THIS PART TO BE COMPLETED BY THE RECOMMENDER

To the Recommender: The person named above is applying for admission to the Graduate School at Keio University. We would
appreciate your personal impressions of the applicant’s intellectual ability, aptitude in research, and/or professional skills. Please comment
on the applicant’s character, the quality of previous work, and the promise of productive scholarship in Japanese or English. If applicable,
please include any known obstacles the applicant may have overcome to attain her or his educational goals (e.g., financial, social, cultural,
educational, or other disadvantages). Please enclose this form in an envelope, seal it, sign it across the seal, and return it to the
applicant.

Please rate this applicant in each category.

Academic Performance □Below Average □Average □Good □Outstanding □Truly Exceptional □Inadequate to Observe

Intellectual Potential □Below Average □Average □Good □Outstanding □Truly Exceptional □Inadequate to Observe

Motivation for Graduate Study □Below Average □Average □Good □Outstanding □Truly Exceptional □Inadequate to Observe

Recommender’s name (please print):

Position or title: School or company:

Address:
Ph. D. Program 2008 Fall Enrollment (IGP-I) For reference use
Graduate School of Science and Technology
Keio University

Signature: Date: