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( Master抯 ( Doctoral When do you wish to start the program? ( April _______ (year) ( October _______(year) *You should choose one of the above. 0Paste a recent photo here( Male ( Female ( Single ( Married  (1) Name _________________________________________________________________ * Write your SURNAME (followed by your first name) in CAPITAL letters here. (2) Nationality _____________________ (3) Date of birth ___________________ (4) Age (at time of enrolment) ________ Year / Month / Day (5) Present mailing address ________________________________________________________________________ ______________________ Postal code ____________________Country______________________ Phone ________________________ Fax _________________________ E-mail ______________________________ (6) Permanent address, if different________________________________________________________________________ ______________________ Postal code ____________________Country______________________ Phone ________________________ Fax _________________________ E-mail ______________________________ (7) Course of study. If you are applying for Master抯 program, please select the one course. Master抯 Program Intelligent Mechanical and Aerospace Engineering Course Electronic and Photonic Engineering Course Architecture and Infrastructure Design Course Engineering Sciences Course Informatics Course Digital Innovation Course Entrepreneur Engineering Management Course Advanced Educational Practice Course (8) Preferred supervisor. If you are applying for Doctoral program, please write your preferred supervisor抯 name. Preferred supervisor抯 name (9) Educational background *Please write down all the schools that you were enrolled in, including the schools that you are now registered. School name, city, countryTime of entrance and completion (month/year)Length of schoolingDiploma/degree awarded, major subject(A) Elementary SchoolSchool name City, Country From / to / years and months(B) Lower Secondary SchoolSchool name City, Country From / to / years and months(C) Upper Secondary SchoolSchool name City, Country From / to / years and months(D) Undergraduate LevelSchool name (*If you are Chinese, write down in both English &Chinese) City, Country From / to / years and months(E) Graduate LevelSchool name0(*If you are Chinese, write down in both English &Chinese) City, Country From / to / years and monthsTotal years of schooling described above years* If the space above is not sufficient, please add more space as needed. (10) Employment record (if applicable) beginning with the most recent employment Employer, city, countryPeriod of employment (month/year)PositionType of workEmployer City, Country From / to /Employer City, Country From / to /* If the space above is not sufficient, please add more space as needed. (11) List of publications (State the titles of books or papers, including graduation theses, with the publisher's name and date of publication. Please attach abstracts.) (12) Academic honours and prizes, if any. (13) Language ability other than your native language.0(Check each section to show your language ability) 0 Speaking Academic reading Academic writingBasicBasic daily conversation Discuss academic material BasicIntermediateAdvancedBasic IntermediateAdvancedIntermediate AdvancedIntermediate AdvancedEnglish 00000000000Japanese00000000000Other 00000000000 *If applicable, give the following information: ?Name of English Exam such as TOEFL, IELTS, TOEIC, CET , etc : ______________ 0 Score: ________________0Test Date: ______________ ?Japanese proficiency test level : _________________0Test Date: _____________00 (14) If you are applying for another institution s scholarship, or if you have already received another institution s scholarship, please give the name of the scholarship and its term. Scholarship nameTerm of the scholarship   (15) If you are applying to other university, give the details in the space below. (16) Have you ever visited Japan? (No (Yes (Period of stay : From to ) month / year month/year * Purpose of stay (e.g. study at school, internship or work):0 ______________________________________ (17) Have you ever lived abroad? ?No0?Yes (please give the following information) 0000(a) Name of country: (b) Period of stay: From to ) (c) Purpose of stay (e.g.study at school, internship or work): ______________________________________ (18) Write the names of two persons whom you have requested to write a letter of recommendation. Name Title Institution a) _______________________________ ________________________ _____________________________________ b) _______________________________ ________________________ _____________________________________ 00 (19) Person to be notified in your country in case of emergency: i) Name in full __________________________________________________________ ii) Address ______________________________________________________________________________________ Phone _________________________ Fax _________________________ E-mail ____________________________ iii) Occupation _______________________________ iv) Relationship ______________________ (20) How did you come to know about the postgraduate programs at KUT? Please circle one or more of the following: 1. From KUT's web page 2. Recommendation from your supervisor or university 3. From an alumnus 4. From a KUT Professor 5. At a study abroad event 6. From the Internet (Web page name: ) 7. 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(2) Any false declaration, false information, or incomplete information on the application form or other application documents including but not limited to omission of information regarding educational background will result in the rejection of my admission or the cancellation of my acceptance into the university. If such a misrepresentation is detected after my enrolment, I will accept any disciplinary actions, such as expulsion from the university or reimbursement of exempted tuition fees or paid scholarship, as decided by KUT. Applicant抯 signature ____________________________________________ Date submitted ____________________ (should be hand-written) 00000000000000000000000000 0 Year / Month / Day Send the completed application form together with other required documents to: International Relations Section Kochi University of Technology Tosayamada, Kami City, Kochi 782-8502, JAPAN TEL: +81 887 53 1130 FAX: +81 887 57 2000 E-mail: international@ml.kochi-tech.ac.jp >?M?N?s?寴洏罉贅闃陿?????M?n?o?曛睛懢yk`UG:GUGh鎝whfOJQJaJh鎝whfOJQJaJo(hfOJQJaJo(h?gOJQJaJo(h鎝wh?gOJQJaJo(/h??h?g>*B*CJOJPJQJ^Jo(ph333)h??>*B*CJOJPJQJ^Jo(ph333/h??h??>*B*CJOJPJQJ^Jo(ph333/h擶h??>*B*CJOJPJQJ^Jo(ph333&h??>*B*CJOJPJQJ^Jph333)hzr?>*B*CJOJPJQJ^Jo(ph333o?p?r?s?t?h?s?嚊垱墰姏摏敍煕矝禌鬀魶????~?€?倻獪矜厮景矩爼坿坿坿垥jYj昇昇Ch匯?CJOJQJo(h匯?CJOJQJo(!h? h?gB*CJOJQJph$h? h?gB*CJOJQJo(phh?g5丆JOJQJh?g5丆JOJQJo(h?gCJOJQJo(hfh?gCJOJQJaJo(h??h鏢LOJQJaJo(h??h鏢LOJQJaJh鎝whfOJQJaJh鎝whfOJQJaJo(hfOJQJaJo(h?hfOJQJaJo(獪蕽虧覞?*?6?9?Q?X?z?啚憺枮煘??挩敤枿波抹权狮台楔舀吱亘塄蕤猕歙糸暨暨粜男郸敌πば枊€vl媎`d`d`d`Wh?gOJQJo(h縚?jh縚?Uh?CJOJQJh:05CJOJQJhT?CJOJQJo(h?gCJOJQJo(h??h?gCJOJQJo(Uh+{/h荗?CJOJQJ^Jh+{/hBJlCJOJQJ^Jhu?CJOJQJ^Jh+{/h?gCJOJQJ^Jh?gCJOJQJh?gCJOJQJo(h?gCJOJQJo(!z?诪??挩敤枿狮唯楔渊吱讪塄啜猕???姪尒帺惄???????????????????????$4$a$ $dL4$a$gdT? 劺dLVD?^劺d轧gd?g ?d轧WD?`?gd?g 00000000000000000*Note: do NOT send application documents via e-mail. 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