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2.1 2.2Please use BLOCK/CAPITAL letters.
PHOTO (4 x 3 cm) Write your name in block letters on the back and paste it.
AIMS Programme (TUAT) Application Form
Home University Information
Name of UniversityName of School / Faculty
Religion We welcome and accept applications from people of all faiths or none at all.
Meal restrictions
Male Preferred first name/nickname Date of birth (dd/mm/yyyy)
Female
Married
Halal Vegetarian Other allergies Please state your country of birth
Nationality Marital Status Single
Gender Date of birth (dd/mm/yyyy)
Title Family name First name Middle name
Town/Suburb
Number and street
Telephone (home)
State/Country p/code
Contact address in case of emergency
Initial Applicant Information
Title Family name First name Middle name
Gender Male
Current address
Female Preferred first name/nickname
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4
5
The language of the programme is my first language From Elementary
School To
A verification issued by a language lecturer which verifies that my language level is equivalent to the proficiency level of TOEFL score of 500 (PBT)
Information necessary for the issue of the Certificate of Eligibility (COE)
Name of the testDate of the test Score/Classification From
To Lower and Upper
Secondary School
Educational Background
Classification Name of School Address of School Required Years of Study
Total Years of Schooling Mentioned Above
Attaching a TOEFL iBT, TOEIC, IELTS or CPE official test scores Specify the detail below.
Years
Years Years
English Proficiency
From
To Undergraduate
Level
Years
Period of Attendance (YYYY/MM))
5.3
5.4 Yes No
5.5
6
On-campus residence (Single)
Off-campus residence (Shared Flat)
Photos of the off-campus residence
28.000 JPY/month + Cleaning expenses (15.000 JPY) Utility bills are not included.
20.000 JPY/month + Cleaning expenses (15.000 JPY) Utility bills are not included.
Accommodation
Please choose your own preferred accommodation from the following options. These will be assigned on a first-come-first served basis when applying.
On-campus residence (Shared Flat)
10.000 JPY/month + Cleaning expenses (15.000 JPY) Utility bills are included. Internet is not included.
The latest departure by deportation Year Month Day
Residence card number
Intended to reside with applicant or not
Place of employment/school
Family in Japan Yes
Fill in the followings when the answer is "Yes"
Departure by deportation/departure order
Relationship Name Date of birth Nationality time (s)
Criminal Conviction Please indicate whether you have been convicted of a criminal offence
Yes No
No
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8
e.g.
e.g.
Chemical Engineering Separation Process
Courses you wish to register
List courses you would like to take below.
※ You are required to take classes that would sum up to the minimum of 14 credits
Code Credits
Motivations for the TUAT
K1 3
P6 2～3
Motivation to apply for the programme (max 500 words in English)
Applied Physics Research Internship P-5 Biophysics
Department Course Title Note
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10
Name of applicant (in block letters)
Signature of applicant Date (DD/MM/YYYY)
Applications must be sent or delivered to Takako Ochi
Associate Professor (AIMS Coordinator)
Tokyo University of Agriculture and Technology Faculty of Engineering
2-24-16 Nakacho Koganei Tokyo Japan 184-8588
Tel: +81-42-388-7989 Fax: +81-42-388-8013 Email: [email protected] Name of the AIMS programme coordinator (in block letters) Signature of applicant
Date (DD/MM/YYYY) Contact address
(Address, Email, Phone number)
Declaration
I certify that all the information provided in this form and the accompanying documents is complete and accurate to the best of my knowledge, and if admitted, I agree to comply with the rules and regulations of Tokyo University of Agriculture and Technology and the Japanese domestic law.
I will also carry comprehensive health insurance valid in Japan, e.g. travel insurance.
