Graduate School of Engineering The University of Tokyo

Application Form for International Graduate Program Academic Year 2012

Please complete all FORMS and do not leave any blank spaces. Please write N/A or NONE if you do not have any applicable answers

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FORM1: PERSONAL INFORMATION

1. Legal name

Write your name in English exactly the same as is printed in your passport,

And complete FAMILY NAME in BLOCK CAPITALS.

2. Please note that your name will appear on all documents at the University of Tokyo in the order of (FAMILY NAME), (First name) (Middle name). Please tick the order in which you want your name to appear on all documents at the University of Tokyo, if possible.

3. Gender

4. Date and Place of Birth

Date of Birth / ( dd/ mm/ yyyy)
Age / as of 01 April, 2012
Place of Birth / (City or Town)
(State or Province)
( Country)

5. Nationality

Country of Nationality /Citizenship
If other, please specify
Do you have Japanese nationality? / □ Yes, I have Japanese nationality.

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Graduate School of Engineering The University of Tokyo

Application Form for International Graduate Program Academic Year 2012

FORM1: PERSONAL INFORMATION

6. Marital Status

7. E-mail address

Provide an e-mail address that can be used for periods including the time before you come to Japan, your stay in

Japan, and the period after you complete master or doctoral course.

E-mail address

8. Address for Correspondence

Address
Country
Postal Code
Telephone
Mobile phone
FAX
Valid until ( mm/yyyy)

9. Permanent Address (if different from “8. Address for Correspondence”)

Address
Country
Postal Code
Telephone
FAX

10. Current Occupation (e.g. a student at XX University, an engineer at YY Company, etc.)

Position
Employer/Organization
Full Address of your office/university including your department
Telephone number
Fax
Valid until (dd/mm/yyyy)

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Graduate School of Engineering The University of Tokyo

Application Form for International Graduate Program Academic Year 2012

FORM2: PLAN FOR STUDY

1. Please select your most desirable research field.Your application will be processed according to the first

priority of research field. If you already know the names of faculty members you would like to study with, please

write them down.

Notes:

a) Your preference cannot be guaranteed due to limited places being offered in the laboratory by

faculty members.

b) You may be assigned to a faculty member within your chosen program due to faculty

members’ availability.

1) / Priority 1 / Research Field
(within 40 words)
Name of faculty member, if any
2) / Priority 2 / Research Field
(within 40 words)
Name of faculty member, if any

2. Statement of Study Plans/Research Proposal

Please submit an outline of your research proposal, including your motivation for selecting this particular department/course. This statement needs to be written on one or two separate sheet of

papers in English with no more than 1,000 words. > (Please provide your answer in the attached form A)

3. Title of your graduation thesis and its abstract

Please tell us about your most recent graduation thesis.

-If you are applying for a Doctoral degree program, please send us a brief statement about your Master’s degree.

- If you are applying for a Doctoral degree program and have not yet started writing the Master’s degree graduation thesis, please send us a summary of your Bachelor’s degree graduation thesis instead.

-If you have not written any graduation thesis, please provide a title of essay/project which is related to your research field.

Title
Its summary / >(Please provide your answer in attached form B)

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Graduate School of Engineering The University of Tokyo

Application Form for International Graduate Program Academic Year 2012

FORM3: ACADEMIC QUALIFICATION

1. Educational Background

Please provide the name of universities and colleges you have attended.

Bachelor Degree

Name of university/Institution attended
Location (City or Town/ State or Province/ Country)
Qualification obtained or studying for (e.g. BA, BSc. etc.)
Major subject (e.g. Chemistry, English)
Start year (mm/yyyy)
Year of completion (mm/yyyy)
Result (GPA, grade, classification etc.)
(Class Rank/Class Size)
(Honors received)

Master Degree

Name of university/Institution attended
Location (City or Town/ Province/ Country)
Qualification obtained or studying for (e.g. ME, MSc., etc.)
Major subject (e.g. Chemistry, English)
Start year (mm/yyyy)
Year of completion (mm/yyyy)
Result (GPA, grade, classification etc.)
(Class Rank/Class Size)
(Honors received)

2. Please list scholarships, prizes, honors, awards and other recognitions, if any. (Please provide your answer in Attached form C)

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Graduate School of Engineering The University of Tokyo

Application Form for International Graduate Program Academic Year 2012

FORM4: ENGLISH LANGUAGE PROFICIENCY

1. Please submit either a) Certificate of English Instruction Medium from your university or b) Official

Test Score from a standardized English Exam as a proof of your English language proficiency.

□ a) Certificate of English Instruction Medium from your university

This document certifies that you attained your previous degree from a university where the medium of instruction is English. The document should be attested and signed by the University Registrar.

□ b) Official Test Score from a standardized English Exam.

*An official test score is valid only for 2 years.

*Minimum score：There is no specific score required by the Graduate School of Engineering. Each

department judges its applicants comprehensively considering its research topics and academic

areas.

*You can provide more than one score at this section.

*Institution Code for TOEFL is 8596.

Test Type / Date Taken
(mm/yyyy) / Test Score
□ / IELTS
□ / TOEFL Paper-based (PBT) Institution Code: TOEFL: 8596
□ / TOEFL Computer-based (CBT) Institution Code: TOEFL: 8596
□ / TOEFL Internet-based (iBT) Institution Code: TOEFL: 8596
□ / TOEIC

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Graduate School of Engineering The University of Tokyo

Application Form for International Graduate Program Academic Year 2012

FORM5: PROFESSIONAL QUALIFICATION

1. Experience

Please list your employment details in chronological order on a separate sheet. > (Please provide your answer in attached form D)

2. List of membership you belong to honor societies and professional organizations.

Please list membership in honor societies and professional organizations you belong to, if any. > (Please provide your answer in attached from E)

3. Please list the titles of publications, major papers, or theses of which you are author or coauthor, if any. If published, please give the citation. > (Please provide your answer in attached form F

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