2018 Division of Health Sciences, Hirosaki University Graduate School of Health Sciences (Master’s Program)

Special Selection of Foreign Students

Application for Recognition of Academic Requirements

To the Dean of Hirosaki University Graduate School of Health Sciences:

(Roman Letters)

Name

Family Name First Name

Signature

Date of Birth

Nationality

Address (Postal Code)

Telephone Number

I am applying for recognition of the following appended documents.

Note

Academic Requirements Seeking Recognition / □Academic Requirements for Special Selection of Foreign Students 2
□Academic Requirements for Special Selection of Foreign Students 3
Name of Previously Consulted Faculty Member / Date of Consultation

* Please check in square. (see I-2. Academic Requirements for Application in Page 1)

*Please also fill out your education and employment history on the reverse side.

Category / Year/Month / Item
Education
Employment History
Academic and Social Activities or Other Experiences

Precautions for filling out this form:

In the Education field, please list your education since graduating high school or secondary school. Do not list home learning or preparatory school(s). For university and graduate school, please list your faculty/school and department (major and program), and your graduate school and major, respectively.

In the Employment History field, please list your place(s) of employment, the department(s) in which you worked, and your job title(s).

In the field for Academic and Social Activities or Other Experiences, please provide a summary of any experiences you have had. If you have had no experiences, please write “None” in this field.

Foreign Students – Form 1 Please leave the box for Examinee Number blank.

Examinee Number

Division of Health Sciences, Hirosaki University Graduate School of Health Sciences (Master’s Program)

Special Selection of Foreign Students

Admission Application Form

(2018 Admission)

Field of Study /
Photograph
(4 cm high × 3 cm wide)
Name
Roman Letters / Family Name First Name
MotherTongue [*1]
Date of Birth (Age) / (Year) (Month) (Day) ( years)
Nationality / Sex / □ Male □ Female
University Information / University / University
Faculty/School
Department
Date of Graduation / (Year) (Month) (Day)
□ Expected to graduate □ Graduated (Please tick the appropriate box)
Graduate School Information / University Graduate School / University Graduate School
Graduate Course
Major
Date of Completion / (Year) (Month) (Day)
□ Expected to complete □ Completed (Please tick the appropriate box)
Current Address
[*2] / Postal code
Telephone / Fax
E-mail Address
Desired Supervisor [*3] / Name
*Please leave these fields blank / □ Self-financed student
□ Japanese government scholarship student
□ Government-funded study abroad

[*1] Foreign students are asked to fill out their surname followed by their given name in 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 of this fact.

[*3] Applicants are asked to obtain the consent of their desired supervisor in advance.

Curriculum Vitae/ResumePlease leave the box for Examinee Number blank.

Name / Roman Letters / Family Name First Name / Examinee Number
MotherTongue [*1]
Year/Month / Items
Education / Elementary School / Admitted
Graduated
Middle School / Admitted
Graduated
High School / Admitted
Graduated
University / Admitted / [*2] National/Public/Private / University Name:
Faculty/School / Department
□Expected to graduate
□Graduated / [*2] National/Public/Private / University Name:
Faculty/School / Department
Master’s Program/ Master’s Course/ / Admitted / [*2] National/Public/Private / University Name:
Graduate Course / Major
□ Expected to graduate
□Graduated / [*2] National/Public/Private / University Name:
Graduate Course / Major
Research Student / Admitted / [*2] National/Public/Private / University Name:
Graduate Course / Department/Major
□ Expected to graduate
□Graduated / [*2] National/Public/Private / University Name:
Graduate Course / Department/Major
Year/Month / Please check the one that applies. / Company Name(s)
Employment History / Start Dateof Employment
□ Currently employed
□ Resigned / Same as above
Start Date of Employment
□ Currently employed
□ Resigned / Same as above
Start Date of Employment
□ Currently employed
□ Resigned / Same as above
Qualifications
Rewards and Disciplinary Actions

[*1] Foreign students are asked to fill out their surname followed by their given name in their mother tongue.

[*2] Please only circle the option that applies and write the university name in the box to the right.

Foreign Students – Form 3 (2018 Admission)

Entrance Examination Fee Remittance Confirmation Form

Division of Health Sciences, Hirosaki University Graduate School of Health Sciences (Master’s Program)

Special Selection of Foreign Students

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

Roman Letters / Family Name First Name / Nationality / Current Country of Residence
MotherTongue [*1]
[*1] Foreign students are asked to fill out their surname followed by their given name in their mother tongue.

Please remit the entrance examination fee of 30,000 yen to the specified bank in accordance with the information below.

*Precautions

An additional “transfer fee” is needed for the wire transfer.

In addition, if the transfer is being made from outside of Japan, a “Japanese bank transaction fee” is needed. 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 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 cautious of this.

(1)Payee

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

(2) Please fill out the sender’s information.

Sender Name / Relation to Applicant
Bank Making Transfer / Account Number / Branch Name
Date of Transfer / (Year) (Month) (Day)
Research History or Performance Report for Specialized Training and English Language Proficiency Report
Name / Roman Letters / Family Name First Name / Examinee Number
MotherTongue [*1] / Please leave the box for Examinee Number blank.
[*1] Foreign students are asked to fill out their surname followed by their given name in their mother tongue.
Summary of Past Research or Results for Specialized Training
Titles of Academic Papers, Research Reports, Patents, etc. / Dates of Publication or Presentation / Names of Publishing Offices, Publishing Journals, or Presenting Academic Societies / Names of Co-authors or Co-presenters
English Language Proficiency / TOEIC score ( ), TOEFL score ( ), IELTS score ( )
*Please write the results of any of the above-mentioned English language proficiency tests and affix a copy of the official score card or official certificate.

(Note) Please affix separate prints or copies of academic papers, etc.

Academic papers currently in the process of submission are not allowed. However, papers accepted for publication are allowed if the manuscript (copy) and certificate of acceptance are provided.

Foreign Students – Form 5 (2018 Admission) Please leave the box for Examinee Number blank.

Examinee Number

Research Plan

Name / Roman Letters / Family Name First Name
MotherTongue [*1]

[*1] Foreign students are asked to fill out their surname followed by their given name in their mother tongue.

Research Topic

Letter of Acceptance and Recommendation From the Desired Research Supervisor

Division of Health Sciences, Hirosaki University Graduate School of Health Sciences (Master’s Program)

Special Selection of Foreign Students

Job Title: Name of Desired Research Supervisor:

Signature :

Name of Applicant:
(Roman Letters)
Family Name First Name / Relation to Applicant:
Please provide details about the progress of the applicant’s research, their specialized knowledge and skills, creativity, communication abilities, English proficiency, leadership abilities, future goals and any other relevant information. Please also provide details on the originality and development potential of the applicant’s research. (If research is being conducted jointly with the applicant, please also describe the applicant’s role and contributions.)

● Precautions for filling out this Letter of Acceptance.

Relation to applicant: For example, supervisor (university, graduate school, etc.), research collaborator, etc.

This Letter of Acceptance and Recommendation will serve as an important evaluation criterion for selection; please fill out this form concisely and in detail.

If the space in the box provided is insufficient, it is fine to add up to one page more.

Please make sure to affix documents showing your correspondencewith the applicant (copies of letters, e-mails, etc.) to this Letter of Acceptance and Recommendation. The desired supervisors of applicants are asked to submit this form themselves directly to the Academic Affairs Group of the Graduate School of Health Sciences.

Foreign Students – Form 7 (2018 Admission) Please leave the box for Examinee Number blank.

Examinee Number

Address Labels

Name (Roman Letters):

Family Name First Name

(Kanji) [Mother Tongue]*:

[*] Foreign students are asked to fill out their surname followed by their given name in their mother tongue in the field for Kanji name.

Postal Code
Address
Name
*Please leave this field blank. / *
Postal Code
Address
Name
*Please leave this field blank. / *
Postal Code
Address
Name
*Please leave this field blank. / *