Application Form (A)

(1)

University of Tsukuba Graduate Admissions 2016

Application Form (A)

(August 2016 Master's Programs)

Master's Programs

August

(Master’s Programs in Geosciences, Biological Sciences, and Agro-Bioresources Science and Technology)

Fill in or circle the following items. (See the Guidelines for Completing the Application Form.) Please do not write in the fields marked with ※.

Examinee Number

※

Application ※ Method①

General

Admission

①

Individuals^Working 2

Research Student/

Others

Application Method②

Coopera- tive Graduate

1

Research Institute

Code

2

Entrance in Fall 4

Status at the Time of Application

Student 1

Worker (except part-

time)

2 ^Legal

Residence

3

Foreign Student Status at the Time

of Application

Govern- ment Sponsored

1 ^Privately

Funded

D Age

Sex Date of Birth (Gregorian calendar)/ Age M F

Y 1 2

Current

Address 　　　　　　　　〔Phone ○○○ （ ○○○ ） ○○○○　〕　　〔Cell Phone　○○○ （ ○○○○ ） ○○○○　〕　　　　　　　　　〔E-mail address ：　○○○○＠○○○○　　　　　　　〕

M

Reference (Inside Japan)

Name ^Relation

-ship

Address ［Phone ○○○ （ ○○○ ） ○○○○　］

Graduate School Name/ Code Program Name/ Code Research Field or Advisor Name Applicants who have contacted the prospective advisor are requested to mark "〇" in the column below.

Graduate School of Life and Environmental

Sciences

8 ア

Exam Subjects

Foreign Language Specialized Subject Related Subject Basic Subject

Foreign Language options for Master’s Program in Geosciences (Choose an option and circle the number.)

1. Submit the IELTS Academic Module Test Report Form 2. Submit the TOEFL Examinee Score Record (photo attached) 3. Submit the TOEIC Official Score Certificate (photo attached) Foreign Language options for Master’s Program in Biological

Sciences

(Choose an option and circle the number.)

1. Submit the TOEFL Examinee Score Record (photo attached) 2. Submit the TOEIC Official Score Certificate (photo attached)

Foreign Language options for Master's Program in Agro- Bioresources Science and Technology

(Choose an option and circle the number.)

1. Submit the TOEFL Examinee Score Record (photo attached) 2. Submit the TOEIC Official Score Certificate (photo attached) 3. Submit the IELTS Academic Module Test Report Form

Eligibility

National 1

University

※

Expect to Graduate Graduated Other

Year and Month of (Expected) Graduation

Public 2

School/ Faculty Year (Gregorian

calendar) Month

Private

Other 5

3

Foreign 4

College/ Department University (Graduate

School)

※

Completed

2 5 1

Other

Year and Month of (Expected) Completion

Public 2

Graduate School Year (Gregorian

calendar) Month

National 1

Private 3

Foreign 4

Program

Other 5

Expect to Complete

Applicable Eligibility ※ 3 4 5

If you have completed (or are attending) a graduate school, write the name in the "Curriculum Vitae."

Note: Foreign students must acquire the residence status of "Student" before the enrollment procedure.

<Attachment>

Attach the "Receipt of examination fee" or "Certificate of postal transfer payment" here.

Secure with glue.

Name

Family Given Other/ Middle

(2)

(August 2016 Master's Programs)

University of Tsukuba Graduate Admissions 2016

Application Form (B)

Graduate School Name/ Code

<Attachment>

Attach the "Receipt of examination fee" or "Certificate of postal transfer payment" here.

Secure with glue.

Note: Foreign students must acquire the residence status of "Student" before the enrollment procedure.

Name

Family Given Other/ Middle

　　　　　　　↑If you have completed (or are attending) a graduate school, write the name in the "Curriculum Vitae."

Applicable Eligibility

※ 3 4 5

Private

3

Foreign

⁴

Program

Other

⁵

Expect to Complete Completed Other

Year and Month of (Expected)

Completion

Public

²

Graduate School

Year (Gregorian

calendar) Month

Other

5

National

¹ ^University (Graduate School)

※

Month

Private

³

Foreign

4

College/

Department 1 2 5

※

Expect to Graduate Graduated Other

Year and Month of (Expected)

Graduation

Public

2

School/ Faculty

Year (Gregorian

calendar)

Exam Subjects General Student Foreign Student

Cooperative Graduate School

System

Foreign Language

Foreign Language options (Choose an option and circle the number.) 1. Submit the TOEFL Examinee Score Record (photo attached) 2. Submit the TOEIC Official Score Certificate (photo attached) 3. Submit the IELTS Academic Module Test Report Form

4. Take the TOEFL ITP test carried out by the program on the examination day

Eligibility

National

1

University

Program Name/ Code Research Field or Advisor Name

Graduate School of Life and

Environmental Sciences 8 ア Master's Program in Environmental Sciences D Reference

(Inside Japan)

Name ^Relation

-ship

Address ［Phone ○○○ （ ○○○ ） ○○○○　］

1 2

Current

Address 　　　　　　　　〔Phone ○○○ （ ○○○ ） ○○○○　〕　　〔Cell Phone　○○○ （ ○○○○ ） ○○○○　〕　　　　　　　　　〔E-mail address ：　○○○○＠○○○○　　　　　　　〕

M D Age

Sex Date of Birth (Gregorian calendar)/ Age M F

Y 3

Foreign Student Status at the

Time of Application

Govern- ment Sponsor-

ed

1 ^Privately

Funded Status at the

Time of Application

Student 1

Worker (except part-

time)

2 ^LegalResi-

dence

2

①

Individuals^Working 2

Research Student/

Others

Coopera- tive Graduate

※

Application

Method① 1

Research Institute

Code

Entrance in Fall 4

Applicants who have contacted the prospective advisor are requested to mark "〇" in the column below.

General Admission

Application Method②

Master's Programs

August

(Master’s Program in Environmental Sciences)

※

Fill in or circle the following items. (See the Guidelines for Completing the Application Form.) Please do not write in the fields marked with ※.

Examinee Number

(3)

履歴書

Curriculum Vitae

氏名

フリガナ

ローマ字

男(Ｍ)

・女(Ｆ)

Sex

生年月日

Date of Birth 19 年月日年齢 Age

国籍 Nationality

在留資格 Resident Status Family nam e First Name Middle Nam e

学校教育 Education

学校名・所在地

Name and Address of School

正規の修学年数 Officially Required Number of Years of Schooling

入学及び卒業年月 Year and Month of Entrance and Completion

修業年数 Period of Schooling

専攻科目

Major Subject if any

学位・資格 Diploma or Degree Awarded

初等教育 Elementary Education

小学校

Elementary School

学校名 Name 所在地 Location

年 yrs

入学 from 卒業 to

年 yrs

中等教育 Secondary Education

中学及び高校 Secondary School

中学 Lower

年 yrs

高校 Upper

年 yrs

高等教育 Higher Education

大学

Undergraduate Level

年 yrs

高等教育 Higher Education

大学院

Graduate Level

年 yrs

以上を通算した全学校教育就学年数 Total Number of Years of Schooling as given Above

年

yrs TOTAL ^年

yrs 休学等、在籍中に修学を中断した期間（理由） Periods of interruption of studies, if any

from 年 yr., 月 mon.～to 年 yr., 月 mon.（）

研究歴 Research Activities (研究生の

経歴を含む。)

研究機関名

Name of Research Institution

所在地

Address

身分

Status

研究機関

Duration of Research 年数

yrs

～

～記入は、日本語又はローマ字体を用いてください。 Please type or print in Japanese or English

( 外国人出願者用 ) (for foreign applicants)

※

受験番号

～～～～～

(4)

Examinee Number

※

(University of Tsukuba Graduate School) Name ^Family ^Given Other/ Middle

Graduate School Program Course/ Field

Graduate School of Life and Environmental Sciences Program:

Course/ Field:

Date of

Birth Y M D

If you have an employment history, describe all of your previous and current jobs including job titles, responsibilities, and research content.

If you need more space, make a photocopy of this form.

Employment

Period Year Month – Year Month Company/

Organization

Full-time Part-time Job Title/ Responsibilities/ Research Content

Employment

Organization

Employment

Organization

Employment Record

(5)

(August 2016 Master's Program) (August 2016 Master's Program)

※

Desktop Reference

Photo Card Card

Graduate School of Life and Environmental Sciences

○ ○

Examinee

Number

※

○ Name

(August 2016 Master's Program)

Name

Program

Photo

<Guidelines for the Completion>

Course Graduate

School

University of Tsukuba

Graduate School

Examinee ※

Number

Cut here

Graduate School

Examinee

Number

Program

Headshot with no hats, taken within the last three

months

Headshot with no hats, taken within the last three

months

Reference Card

Name

※

Course Master's Program

Photo

(4 x 3cm)

Program Program

Exam Subjects

Program Master's Program

○

Cut here

F

Master's Program Course

Cut here Cut here M

Graduate School

・ M

　　Acceptance Card Exam Subjects Foreign LanguageSpecialized SubjectSex Date of Birth (Gregorian calendar)

Name D

Foreign Language

Specialized Subject

Related Subject

Basic Subject

Examinee Number Y

(4 x 3cm)

(Attach identical photographs.) (Attach identical photographs.)

Exam Subjects

Foreign Language

Specialized Subject

Related Subject

Basic Subject

• Attach your photographs and enter

your name and exam subjects.

• In the Exam Subjects fields, enter the

same information as on the Application

Form.

• Cut out along the lines.

(6)

(Master’s Program in Environmental Sciences)

(Note) Please do not write in the fields marked with ※.

1) In the “Research Theme” field, describe your chosen research theme in reference to the description of the advisor’s research.

2) Foreign applicants may complete this form in English.

Examinee Number

※

Name ^Family ^Given Other/ Middle

Date of Birth Y M D

Education

Name of University

Faculty Department

Cluster Program

Y M D

Graduated / Expect to graduate Research

Theme 1)

Prospective advisors you have contacted

Describe your motivation for applying to this graduate school, details of your research, future career plans and how your research relates to them. 2) (within 400 words)

Keywords:

.

Research Proposal

(7)

受験番号

Examination No.

※

外国人出願者調書

Questionnaire for Foreign Applicants

１．筑波大学の志望研究科生命環境科学研究科

Graduate Program of the University of Tsukuba you wish to apply for:

志望専攻名、コース・分野名専攻コース・分野

Name of Main Field and Course ／ Field :

Main Field : Course ／ Field :

２．氏名 (Name) 国籍 (Nationa1ity)

生年月日 (Birth Date) 19 年 (yr.) 月(mon.) 日(day)

３．現に日本の大学に在籍している場合は、大学、学群・学類（学部･学科）、研究科、専攻及び身分を記入してください｡

If you are currently enrolled in a Japanese university, please fill in the name of the University, Faculty, Department, Program, Main Field and your current status.

〔（）内の該当するものに○印〕(Please circle the item that applies to you)

学群･学類 (Cluster ／ Co11ege)

大学学部･学科 (Faculty ／ Department)

(University) 研究科 (Graduate School)

年次 (Year of study)

専攻研究生 (Research Student)

(Main Field) その他 (Other)

４．次の質問にお答えください｡〔( ) 内の該当するものに○印〕

Please answer the following questions. (Circle the item that applies to you)

○現に奨学金を受けて（いる。いない。）

Presently (I am ／I am not ) the recipient of a scholarship.

○現に奨学金を受けている場合、その種類は In case you are receiving a scholarship, this is

[ 日本国政府文部科学省奨学金、その他の日本国政府奨学金（JICA など）、民間奨学金（奨学金名）、

母国政府奨学金、その他（）]である。

[ A Monbukagakusho scho1arship, other type of Japanese Government scholarship (ex. JICA, etc.), a private scholarship (name: ), a scholarship offered by the government of your home country, other( ) ].

(注)本調書は、外国人出願者全員が提出してください｡

Note: All foreign applicants are requested to submit this questionnaire.

(8)

受験番号

※

研究歴証明書

Certificate of Research Activities

国籍 ( Nationality )：

氏名 ( Name )：

生年月日 ( Date of Birth )：

上記の者は、下記のとおり研究歴を有することを証明する。

This is to certify that the above person engaged in the research activities as follows.

記

在籍した機関、部局名及び身分 (Status and Institution Attended)

研究期間

(Duration of Research)

年月日から年月日まで ( 年か月間）

From : to : ＝ ( Day ) ( Month ) ( Year ) ( Day ) ( Month ) ( Year ) (Years) (Months)

研究題目及び研究内容 (Title and Outline of Research)

指導教員職・氏名 (Name and Position of

Academic Advisor)

年月日 (Date) ：

署名

(Signature) ：

氏名

(Name) ：

職名（注）

(Title＊) ：印

機関名

(Institution)：

所在地

(Address of Institution)：

(注) 証明者は、機関の長等（例えば、学長又は学部長等）とします。

(＊The title of the certifier should be equivalent to representative of organization such as President, Dean, Director, etc)

様式 (外国人出願者用 ) Form (for foreign applicants)

(9)

300 Address Sheet #1

1. Please do not write in the fields marked with ※.

2. The address sheets will be used to send out acceptance letters and enrollment documents to the successful applicants. Enter the mailing address and name clearly in block letters.

3. If you enter the name and address of a person other than the applicant, enter the applicant’s name in the box しかく.

Program

Master’s Programs Graduate School of Life and

Environmental Sciences Program

Name

Examinee Number ※

※

.

(10)

(August 2016 Master’s Programs)

University of Tsukuba Graduate Admissions 2016 List of Documents to be Submitted

Graduate School

Graduate School of Life and

Environmental Sciences Program Name ^Family ^Given Other/ Middle

Note: Make sure to mark “○” in the “Check” columns for documents to be submitted. Your application may not be accepted

unless all the required documents are submitted.

Documents Check Required for Remarks

[University of Tsukuba designated forms]

Application Form All applicants

Curriculum Vitae for Foreign

Applicants All foreign applicants

Employment Record All applicants who have employment history Reference Card/ Photo Card/

Desktop Reference Card/

Acceptance Card

All applicants Questionnaire for Foreign Applicants All foreign applicants

Research Proposal Master’s Program in

Environmental Sciences Certificate of Research Activities Foreign applicants who meet the

conditions

Address Sheet #1 All applicants To be used to send out acceptance letters and other documents from the University of Tsukuba List of Documents to be Submitted All applicants

Address Sheet #2 All applicants Prepare an envelope (for A4 size) and attach this sheet to it to submit the application documents.

Examination Fee (“Certificate of postal transfer payment” or “Receipt of examination fee” of 30,000 yen)

All applicants

Attach to the specified column of the Application Form.

Not required for government-sponsored foreign students

[Certificates and other documents to be prepared by applicants]

(Expected) Graduation Certificate All applicants

Degree Certificate Applicants who meet the conditions

Academic Transcript All applicants

Research Proposal (Format of your choice)

Biosystem Course, Master’s Program in Agro-Bioresources Science and Technology

A4 size paper, horizontally on portrait-oriented, within 800 words (up to 2 pages)

IELTS Academic Module Test Report Form, TOEIC Official Score Certificate (photo attached) or TOEFL Examinee Score Record (photo attached)

Master’s Program in Geosciences

Submit the TOEIC Official Score Certificate (photo attached) or TOEFL Examinee Score Record (photo attached) at the time of application. Scores on tests taken within two years before the application deadline are valid. Photocopies are not accepted

General students for Master’s Program in Biological Sciences

Submit the TOEIC Official Score Certificate (photo attached) or TOEFL Examinee Score Record (photo attached) at the time of application. Scores on tests taken within two years before the application deadline are valid. Photocopies are not accepted

Master’s Program in

Agro-Bioresources Science and Technology

Submit the IELTS Academic Module Test Report Form, TOEIC Official Score Certificate (photo attached) or TOEFL Examinee Score Record (photo attached) at the time of application. Scores on tests taken within two years before the application deadline are valid. Photocopies are not accepted

Master’s Program in Environmental Sciences

Submit the TOEIC Official Score Certificate (photo attached), TOEFL Examinee Score Record (photo attached) or IELTS Academic Module Test Report Form at the time of the examination on the specialized subject. Scores on tests taken within two years before the application deadline are valid.

Photocopies are not accepted

Letter of Approval for Taking the Entrance Examination

(Format of your choice)

Applicants who currently attend a university or graduate school Applicants who currently work for a government agency, school, or company

Not required for students who will graduate or complete in March 2016

Not required for part-time workers A4 size

Certificate of Government-Sponsored Foreign Student

Foreign applicants who meet the conditions

Reply Envelope

(with a 362 yen postage stamp attached)

All applicants

Prepare a N3 size envelope with the applicant’s zip code, address, and name written and a 362 yen postage stamp attached. [This will be used to send you your reference card.]

Applicants living overseas are requested to contact us. Contact information can be found in

“11. Contact Us.”

受付月日 ^※ 月日受付者 ^※ 点検者 ^※

※欄は記入しないでください。

※ 国費私費 ^※

郵外

有職者連携大学院

受験番号

※

(11)

(Address Sheet #2)

速達

3 0 5 ⁸ ⁵ ⁷ ⁷

Express Mail Service

E x pr es s M ai l S er v ic e ( A ppl ic at ion D oc um ent s E nc los ed)

書

留

速

達（

出

願

書

類

在

中）

Graduate School of Life and Environmental Sciences Program:

Course/ Field:

Foreign Student Status

Government Sponsored

Privately Funded General Admission Working Individuals

Application Form (A)

University of Tsukuba Graduate Admissions 2016