APPLICATION FOR INTERNATIONAL JOINT EDUCATION PROGRAM

FOR SCIENCE AND TECHNOLOGY (IJEP)

GRADUATE SCHOOL OF SCIENCE AND TECHNOLOGY,

KUMAMOTO UNIVERSITY

INSTRUCTIONS Paste your passport photograph

1. The application should be typewritten if possible, or neatly handwritten in block letters. taken within the past 6 months.

2. Numbers should be in Arabic figures. Write your name and

3. Year should be written in the Anno Domini system. nationality in block letters on

4. Proper nouns should be written in full, and not be abbreviated. the back of the photo.

5. Check the appropriate box ☑. （６×４㎝）

Application for
□ April 2025Admission □ October 2025 Admission
□ Master’s Course □ Doctoral Course

Prospective Supervisor

1. Name in full, in native language __________________________, ___________________________________ (Sex)

(Family name) (First name) (Middle name) □ Male

□ Female
In Roman block capitals________________________, ____________________________________________ (Marital Status)

(Family name) (First name) (Middle name) □ Single

□ Married
2. Nationality_____________________________________________________

3. Date of birth

Year Month Day Age

4. Present status; with the name of the university attended, or of the employer

5. Present address and telephone number, facsimile number, E-mail address

Present address：

Telephone/Facsimile number：

____________________________________________________________________________________________________

E-mail address:

____________________________________________________________________________________________________

6. Field of study specialized in the past (Be as detailed and concrete as possible.)

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7. Educational background

Year and Month of Period of

Diploma or Degree awarded,
Name and address of school Entrance and schooling you Major subject
Completion have attended

Name From yrs

Elementary Education

and
Elementary School
Location To mons

Name From yrs

Secondary Education

and
Lower Secondary School
Location To mons

Name From yrs

Upper Secondary
School and
Location To mons

Name From yrs

Higher Education

and
Undergraduate Level
Location To mons

Name From yrs

Graduate Level and

Location To mons

Total years of schooling mentioned above yrs

＊ If the blank spaces above are not sufficient for information required, please attach a separate sheet.

8. Publication list (extend the table as needed)

Title
Author(s)
Journal
Vol. page
Year
Title
Author(s)
Journal
Vol. page
Year

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9. Employment record: Begin with the most recent employment, if applicable.

Name and address of organization Period of employment Position Type of work

From
To

From
To

10. Accompanying dependents (Provide the following information if you plan to bring any of family members to Japan)

＊ All expenses incurred by the presence of dependents must be borne by the grantee. He/She is advised to take into consideration various
difficulties and great expense that will be involved in finding living quarters. Therefore those who want to accompany their families are well
advised to come alone first and let them come after a suitable accommodation has been found.

Name Relationship Age

11. Person to be notified in applicant's home country, in case of emergency:

ⅰ) Name in full:

ⅱ）Address: with telephone number, facsimile number, E-mail address

Present address ：

Telephone/Facsimile number ：

E-mail address ：

ⅲ) Occupation :

ⅳ) Relationship:

12. Immigration records to Japan

Date Purpose
From
To
From
To

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 Date of application：

________________________________________________

Applicant's signature：

________________________________________________

Applicant's name
（in Roman block capitals）
：

________________________________________________

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(Appendix)

Field of Study and Study Program

Name in full, in native language , _____________________________________________

(Family name) (First name) ( Middle name)

Nationality

Proposed study program in Japan (State the outline of your major field of study on this side and the details of your study program on the backside
of this sheet. This section will be used as one of the most important references for selection. Statement must be typewritten or written in block
letters. Additional sheets of paper may be attached if necessary.)

1. Field of study

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2. Study program in Japan in detail