Application Packet Cover Sheet
Date:Date / Month / Year
Name of Applicant:
Home University:
The application packet must include all of the following documents:
q Application Form for Summer Program 2014 *
q Certificate of Enrollment *
q Academic Transcript *
q Letter of Recommendation *
q 3 Photographs (4×3 cm, taken within the last 6 months) *
q Proof of Foreign Language Proficiency (TOEFL or JLPT, etc.)
Note 1: Documents with Red Marks * are mandatory.
Note 2: These documents must be written in either Japanese or English. A document in any other language must be attached with a Japanese or English translation.
Please submit applications to the Global Support Office at the Center for International Relations, University of Miyazaki. Alternatively, if you are enrolled at a university that has an exchange agreement with the University of Miyazaki, please submit your application through the office for international exchange at your home university.
Application deadline: 31 March ,2014
Global Support Office, Center for International Relations, University of Miyazaki
1-1, Gakuen Kibanadai-nishi, Miyazaki, 889-2192, Japan
Tel : +81-985-58-7134 Fax : +81-985-58-7782
Email:
http://www.of.miyazaki-u.ac.jp/~kokusai/englishpage/index.html
Application Form for Summer Program 2014
(1) Full Name in Native Language:
(Family name) (First name) (Middle name)
(2) Name in Roman Block Capitals:
(Family name) (First name) (Middle name)
(3) Nationality:
(4) Date of Birth: (Male／Female)
Day Month Year Age
(5) Passport No. / Expiration Date:
/
Day Month Year
(6) Current Address:
(7) Tel / Fax: ／
E-Mail Address:
(8) Home University:
Name of University: Country:
Major:
Year in School: □Undergraduate □Masters □Doctorate
□ 1 □ 2 □ 3 □ 4
(9) Foreign Language Proficiency
Language / Excellent / Good / Intermediate / PoorEnglish
Japanese
(other)
If you have a proof of foreign language proficiency, please provide your score:
TOEFL :
JLPT (Japanese Language Proficiency Test) :
:
(10) Reasons for applying for UOM Summer Program:
(11) Choice of Courses (please check the box):
I. “Learn about Japan and Miyazaki and University of Miyazaki”
: Japanese language, Japanese culture and laboratory research course
q Course A (3 credits)
1. Japanese Language (1 credit)
*Please choose between Basic Japanese I and Basic Japanese III.
□ Basic Japanese I (Introductory Level)
□ Basic Japanese II(Elementary Level)
□ Basic Japanese III (Intermediate-Advanced Level)
2. Japanese Culture (1 credit)
*Please choose between Japanese Culture A and Japanese Culture B.
□ Japanese Culture A (main language: Japanese)
□ Japanese Culture B (main language: English)
3. Laboratory Research (1credit)
q Course B (2 credits)
1. Japanese Language (1 credit)
*Please choose between Basic Japanese I and Basic Japanese III.
□ Basic Japanese I (Introductory Level)
□ Basic Japanese II(Elementary Level)
□ Basic Japanese III (Intermediate-Advanced Level)
2. Japanese Culture (1 credit)
*Please choose between Japanese Culture A and Japanese Culture B.
□ Japanese Culture A (main language: Japanese)
□ Japanese Culture B (main language: English)
q Course C (2 credit)
1. Japanese Language or Japanese Culture (1 credit)
* Please choose JLC or JCC:
2. Laboratory Research (1credit)
* Please write a supervisor’s name if you choose the Engineering or Agriculture Laboratory Research Course.(Medical course is omnibus style)
You can find a supervisor’s name at our homepage (in the list of research fields).
Ⅱ．Training program on the conservation, management and use of genetic resources: a part of the curriculum for certification of genetic resource curator
*This course is for the Graduate student
□I’d like to take this training (II only)
□I’d like to take this training and Course A or B or C ( I and II )
*If you choose this course please check the box of previous page .
(12) Person to be notified in applicant’s home country in case of emergency:
a) Full Name:
b) Contact Information:
Current address:
Tel / Fax: ／
E-Mail Address:
I affirm that the above statements are complete and accurate to the best of my knowledge. If admitted to the Summer Program, I agree to abide by the rules and regulations of the University of Miyazaki.
Application Date:Applicant’s Signature:
Applicant’s Name:
(in Roman block capitals)
Pledge
To: President, University of Miyazaki
1. I understand the purpose of the University of Miyazaki Summer Program, and I pledge myself to observe the following articles:
(a) To obey the rules and regulations of the University of Miyazaki, and to devote myself to my studies in order to meet the standards of the Program.
(b) To refrain from violating Japanese laws and regulations.
(c) To accept responsibility for payment of any debts I might incur in Japan.
(d) To accept responsibility for payment of any medical expenses I might incur in Japan.
2. If I am judged by the President of the University of Miyazaki to have violated any of the articles above, I will accept liability without complaint.
3. I will return to my home country when the program is completed.
Date:Nationality:
Applicant’s Signature:
Applicant’s Name:
(in Roman block capitals)
Home-stay Application Form
(1) Nationality:
(2) Home University:
Name of University:
Major:
Year in School: □Undergraduate □Masters □Doctorate □ 1 □ 2 □ 3 □ 4
(3) Full Name in Native Language:
(Family name) (First name) (Middle name)
(4) Name in Roman Block Capitals:
(Family name) (First name) (Middle name)
(5) Date of Birth: (Male／Female)
Day Month Year Age
(6) E-Mail Address:
*Host family may contact you in advance.
(7) Period of home-stay: 19 July 2013 - 21 July 2013
*The Schedule is subject to change.
(8) Foreign Language Proficiency
Language / Excellent / Good / Intermediate / PoorEnglish
Japanese
(other)
(9) Please describe your and interests in Home-stay Program.
(10) If there is something you cannot eat (for religious / food-allergenic reasons), please write it here.
(11) Do you smoke? ( Yes ／ No )
(12) Do you drink alcohol? ( Yes ／ No )
(13) Do you have animal allergy? ( Yes ／ No )
*If you choose t”Yes” please write the name of Animal. ( )
(14) Religion
(15) Hobbies
(16) Others
Survey Questionnaire
Japanese Language and Japanese Culture Courses
Name:
Major: (year in school: )
(1) Have you ever studied Japanese language before? ( Yes / No )
If yes:
1. Where did you study Japanese?
□ junior high school □ high school □ university
□ Japanese language school □ self-study
□ other ( )
2. How long did you study Japanese?
□ 0 - 6 months □ 6 months - 1 year □ 1 - 2 years □ more than 2 years
3. Have you taken the Japanese Language Proficiency Test?
□ Level 4 □ Level 3 □ Level 2 □ Level 1 □ never taken
(2) Please write an introduction of yourself.
(3) Please describe your interests in Japan.
(4) Please write your request for the program.
Thank you very much. We are looking forward to seeing you in Miyazaki soon.
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*Information submitted here will only be used to the extent of this Program.