Kobe University Graduate School of Medicine (Doctoral Course)

Kobe University Graduate School of Medicine (Doctoral Course)

Application Form for Admission in October 2017

For international applicants

*Examination number:
(Leave this space blank) / Paste your photograph
taken within 3 months.
Write your name and
nationality in block letters
on the back of the photo.
(4.5×6.0cm)
INSTRUCTIONS
１．The application should be typewritten or handwritten in Roman block letters.
２．Numbers should be Arabic numerals.
３．Years should be written using the Anno Domini system.
４．Proper nouns should be written in full, and should not be abbreviated.
Fill-in Date 2017, ,
Year, Month, Date
１．Name in full
In native language
， ，
Family name First name Middle name
In Roman block
， ，
Family name First name Middle name
Pronunciation (Japanese KATAKANA or HIRAGANA) / (Sex)
□Male
□Female

２．Nationality

３．Date of birth 19 ， ， ．

Year Month Date Age

４．Enrollment period October, 2017

５．The division you wish to apply to

(Division) (Professor)

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

Present Address：

Telephone/Fax number：

E-mail address：

７．Person to be notified in applicant's home in case of emergency:

Name in full： (Relationship)

Present address：

Telephone/Facsimile number：

E-mail address：

８．Educational background

Name and Address of School / Year and Month
ofEntrance
andCompletion / Period of
Schooling you
have received / Diploma or
Degreeawarded Majorsubject
Elementary Education
Elementary School / Name
Location / From
To / yrs
and
mos
Secondary Education
Lower Secondary
School / Name
Location / From
To / yrs
and
mos
Upper Secondary
School / Name
Location / From
To / yrs
and
mos
Higher Education
Undergraduate Level / Name
Location / From
To / yrs
and
mos
Graduate Level / Name
Location / From
To / yrs
and
mos
Total years of schooling mentioned
above / yrs

＊If you need more space for your educational background, please attach a separate sheet.

９．Present status : with the name of the university attended or of employer.

I hereby declare that the aboveinformation is true and correct.

Date

Name

Signature

Examination Slip

Kobe University Graduate School of Medicine(Ph.D Course)

For international applicants

*Examination number:
(Leave this space blank) / Paste your photograph
taken within 3 months.
Write your name and
nationality in block
letterson the back of
the photo.
(4.5×6.0cm)
Name (In native language):
□Male
□Female
Name (In Roman block):
Date of birth:
Admission: October, 2017
The division you wish to apply to:
Payment Confirmation
(Application fee remittance from abroad)
*Examination Number:
(Leave this space blank)
Name:
(In Roman block)
Date of Payment:
Bank Name
(in your country):
Beneficiary Bank: Check one of the following banks.
□ Sumitomo Mitsui Banking Corporation
□ Bank of Tokyo-Mitsubishi UFJ
*Be sure to attach a copy of receipt.

How to Pay Application Fees in Foreign Countries

The application fee is 30,000 Japanese yen.

When paying from overseas, please make payment by Bank Transfer via foreign remittance in Japanese yen to the designated bank account as specified below. The remittance charges should be borne by the applicant while Kobe University covers any other commissions including lifting charge or handling fees. No overseas remittance checks will be accepted.

A photocopy of receiptmust be attached to your application form.

１．

Bank name / Sumitomo Mitsui Banking Corporation
Bank code / 0009
Swift Code / SMBCJPJT
Branch / Rokko
Branch Code / 421
Account No． / 4165080
Recipient / KobeUniversity

２．

Bank name / Bank of Tokyo-Mitsubishi UFJ
Bank code / 0005
Swift Code / BOTKJPJT
Branch / Kobe-chuo
Branch Code / 453
Account No． / 1164161
Recipient / KobeUniversity

※The following information should be included with your payment.

Purpose of Remittance: Admission Fee

Message: D55 and applicant’s name

(Please put “D55” before your name.)

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