邢唷??>? ?????欹?[?餜?悾bjbj  4?pa!\pa!\?D?@ @ ??,,,8d? ,??222???p5r5r5r5r5r5r5$y9?/<????T@??????22"w6??????822p5??p5????|?2鄮xl4栌Y!?p3\5?0??Z?!??$???€??^???tbi????????????????????????@ N ?: KOCHI UNIVERSITY OF TECHNOLOGY GRADUATE SCHOOL OF ENGINEERING  Ordinary Program Application Form for April 2019 IMPORTANT NOTE: Type or write in block letters.* Unclear or incomplete applications will not be considered. In which program do you wish to enrol? ( Master抯 ( Doctoral 0 0 Paste 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 Engineering Course Aerospace Engineering Course Energy Engineering Course Electronic and Photonic Engineering Course Infrastructure Systems Engineering Course Environmental and Mathematical Sciences Course Chemistry Course Life Science and Technology Course Materials Science and Engineering Course Informatics Course Entrepreneur Engineering Management Course Advanced Educational Practice Course (8) 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. (9) 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. (10) 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.) (11) Academic honours and prizes, if any. (12) 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 : _________________0Score: ________________ ?Japanese proficiency test level : 0_________________00 (13) If you are applying for another institution抯 scholarship, or if you have already received another institution抯 scholarship, please give the name of the scholarship and its term. Scholarship nameTerm of the scholarship   (14) If you are applying to other university, give the details in the space below. (15) 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 ______________________________________ (16) 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): ______________________________________ (17) Write the names of two persons whom you have requested to write a letter of recommendation. Name Title Institution a) _______________________________ ________________________ _____________________________________ b) _______________________________ ________________________ _____________________________________ 00 (18) 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 ______________________ (19) 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. 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From an alumnus 4. From a KUT Professor 5. At a study abroad event 6. From the Internet (Web page name: ) 7. Other ( ) I understand the following two points: (1) Missing or incomplete required documents will result in the rejection of my application. (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 \?]?_?q?y?z?{?}?弻脤鎸????B?Z?s?倣疝娃筐薨饦€kZ餒榾3)hzr?>*B*CJOJPJQJ^Jo(ph333#h?h盻kCJOJQJ^JaJo( hzr?h??CJOJQJ^JaJ)h??>*B*CJOJPJQJ^Jo(ph333/h??h??>*B*CJOJPJQJ^Jo(ph333/h擶h??>*B*CJOJPJQJ^Jo(ph333h鯢?CJOJQJ^JaJo(h??CJOJQJ^JaJ h?h??CJOJQJ^JaJ#h?h??CJOJQJ^JaJo(h盻kCJOJQJ^JaJo(?儘褝m?晭髱 ? ? ?w?畵皳矒磽R?T?様財????????????????? ?d轧WD?`?gd?g ?d轧WD?`?gd?gdL$dN?gd?g 勆WDb`勆gd?g 動VDb^動gdf 動WDb`動gdfgd?gd俐gd?? 刱d俐WD?`刱gd盻k倣儘◢翇袓褝鰨??C?\?l?m?攷晭棊槑檸袔駧驇煸姬煸紥约抸laVH;HVHh鎝whfOJQJaJh鎝whfOJQJaJo(hfOJQJaJo(h?gOJQJaJo(h鎝wh?gOJQJaJo(/h??h?g>*B*CJOJPJQJ^Jo(ph333)h??>*B*CJOJPJQJ^Jo(ph333)hzr?>*B*CJOJPJQJ^Jo(ph333/h??h??>*B*CJOJPJQJ^Jo(ph333/h擶h??>*B*CJOJPJQJ^Jo(ph333&h??>*B*CJOJPJQJ^Jph333驇髱鯉鰩鲙霅鰫 ? ? ? ???"?5?8?v?w?啈噾帒?`?b?d?垝寬矜厮景矩爼坿坿坿垥jYj昇昇Ch匯?CJOJQJo(h匯?CJOJQJo(!h? h?gB*CJOJQJph$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(寬瑩畵磽?6?N?T?剶挃財饠??"?&?钑?挗敘枹并娶盛挞孝尧症丌堍蔻猗膦糸暨暨粜男郸敌πば枊€v媙jnjnjnjah?gOJQJo(hs ?jhs ?Uh:05CJOJQJhT?CJOJQJo(h?gCJOJQJo(h??h?gCJOJQJo(Uh+{/h荗?CJOJQJ^Jh+{/hBJlCJOJQJ^Jh?qCJOJQJ^Jh+{/h?gCJOJQJ^Jh?gCJOJQJh?gCJOJQJo(h?gCJOJQJo( 財2?挄鏁钑挗敘枹盛微孝寓症冖堍啖猗???姡專帲悾???????????????????????$4$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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