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Application for Admission

Type or write in a legible hand with black or blue ink. Check the appropriate boxes.

I.Applicant’s Information

1. Name

(1)In English

LAST (FAMILY) / First (Given) / Middle
LAST (FAMILY) / First (Given)

(2) In Chinese Characters if applicable

(3) In Japanese Katakana if applicable

(4) The order of the name in your country

Last-(Middle)-First First-(Middle)-Last Other than the above ( )

2. Gender Male Female 3. Nationality

4. Date of Birth //(Age:as of April 1, 2019) 5. Marital Status SingleMarried

yyyy/mm/dd

6. Applying Program and Department Master’s program Doctoral program

Department Mathematics Physics Astronomy

Geophysics Chemistry Earth Science

7. Name of Prospective Supervisor

[You MUST obtain consent from your prospective supervisor BEFORE APPLICATION!]

8. Current Status*

Bachelor Student Master’s Student Doctoral Student Research Student

Employed in the position of (Teaching Research) Employed at a Company
Other ( )

Name of School/Employer / Status/Title if employed
*From when you have been in the above mentioned current status? -> / From(/) yyyy/mm

9. Postal Address Residence Office/Lab Other( )

Country / Postal Code / Phone / Fax (if available)
10. Email Address

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II. Academic Background

1. Educational History

Level / Name of School
(Also in Chinese characters if applicable) / City & Country / Required Years toComplete / Actual Attendance / Degree and/or Major
from
(yyyy/mm) / to
(yyyy/mm) / Years
Example / Faculty of Science, Tohoku University
東北大学理学部 / Sendai, Japan / 4 / 2015/ 4 / 2019/ 3 / 4 / Bachelor of Science in Physics
Elementary
(Primary) / / / /
Lower Secondary
(Junior High) / / / /
Upper Secondary
(Senior High) / / / /
University
(Undergraduate) / / / /
University
(Graduate) / / / /
/ / /
/ / /
Total years of school education (as of September30, 2019
2. Additional Educational/Research Experience / 3. Honors and Scholarships
To add more, attach an additional sheet. / To add more, attach an additional sheet
.

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III. Application Status

1. Do you wish to apply for the MEXT scholarship (category: University Recommendation)?

Yes, I wish to apply for the MEXT scholarship. → A, B C

No, I doNOT need to apply for the MEXT scholarship. → A & C

A. Have you ever received the MEXT (Japanese Government) scholarship?

YES NO

If YES, describe the name of the (1) program, (2) host institution, and (3) its term.

(1)
(2)
(3) / From / / / to / /
yyyy/mm / yyyy/mm

B. Do you intend to enter IGPAS even if you are NOT awarded the

MEXT scholarship? YES NO

C. Are you applying for, or going to receive, any other scholarships? YES NO

If YES, provide some information of the scholarship.

(e.g. name/sponsor/duration/amount of the scholarship, when the result will be announced, etc.)

2. Are you applying for any other graduate schools? ** YES NO

3. List institutions, programs, or positions you are currently applying for.* (OPTIONAL)

**The answer(s) will not prejudice your application for admission.

4. Have you ever visited Japan? YES NO

If YES, provide the information on the most recent (or longest) stay in Japan.

Term (from yyyy/mm to yyyy/mm) / Purpose of Stay (e.g. Sightseeing, To participate in exchange programs, etc.)

Important! Your signature

↓ ↓ ↓

Applicant Certification

I hereby certify that the information on this application form is true and complete.

I understand that the falsification in any of the information on the form may result in admission denial.

Signature / Date / /
yyyy/mm/dd