KANAZAWA UNIVERSITY SHORT-STAY PROGRAM 2015
(KUSS2015)
* Use this sheet as a coversheet.
Name of Applicant
Applicant's Home Institution
*This application form should be thoroughly filled out and sent to International Student Section at Kanazawa University by September 4, 2015, together with all of the following documents through theoffice of international student exchange at the applicant's home institution.
check
- Academic Record (issued by applicant's home institution)
*Original should be sent by Post. / □
2. Applicant’s photos (（3:4）,JPEG or other digital file) / □
3. Photocopy of the applicant's passport (if unavailable at the time of application, send it later)
(PDF format) / □
Deadline:September 4,2015
For Contact and Inquires:
Address: International Student Section
Kanazawa University
Kakuma, Kanazawa 920-1192
JAPAN
E-mail:
TEL: +81-76-264-5843
FAX: +81-76-234-4043
INSTRUCTION
・Application should be filled outin English.
・Numbers should be in Arabic figures.
・Years should be written according to the Western calendar.
・Proper nouns should be written in full, no abbreviations.
1. Name in full
1) Roman alphabet / *Must be the same as your passport / PHOTO
Size
(3cmx4cm)
Family name / First name / Middle name
2) in Chinese characters （only if applicable)
Family name / First name / Middle name
2. Nationality
3. Sex / □ Male / 4. Marital status / □ Single
□ Female / □ Married
5. Date of birth / 1 / 9 / Age
Year / Month / Day / ↑As of December 1, 2015
6. Place of birth / Country / City,etc.
*in Roman alphabet
7. Current address, telephone number, fax number and e-mail address
Address:
Phone: / Fax:
e-mail:
8. Person to be notified in applicant's home country, in case of emergency
(1) Full name / (2) Relationship to applicant
(3) Address, telephone number and fax number
Address:
Phone: / Fax:
9. Home Institution
Name of Institution / Faculty/Graduate school / Department
Enrollment
Year / Month / ↓ Please circle one.
School year as of December1, 2015 / [2nd /3rd ] year ofundergraduate program
10．Major field(s) of study
11．Language proficiency
Please markyour level withtick (✓)asappropriate.
Language / Excellent / Good / Fair / Poor
English
Japanese / Applicant’snative language(S)
Others
( )
(1) Proficiency in Japanese
a.How long have you studied Japanese?
Total of / Year(s) / Month(s)
b.Please fill in below.
Name of school(s) where you studied Japanese / Period of study / Textbook(s)
c.If you have passed the Japanese Language Proficiency Test, please circle the level that you hold.
⇒ Level 1 / 2 / 3 / 4 or N1 / N2 / N3 / N4 / N5
d. Have you ever been to Japan? Yes □ No □
If yes, how many times?
12．Scholarship
Do you apply for the Japan Student Services Organization (JASSO) scholarship?
□Yes.
□No. I do not apply for the JASSO scholarship.
* JASSO scholarship recipients mustsubmit documentswhich show that the credits from our university are recognizedby /transferredtotheir home university after participating in KUSS.
13．Essay in support of your candidacy
*Please state why you wish to participate in Kanazawa University Short-Stay Program 2015.