Okinawa International Marine Science Program Graduate School of Engineering and Science Course

University of the Ryukyus

APPLICATION FORM

INSTRUCTION (BRhka)e)

I . Application should be typewritten or written in Roman block capitals. hid&@^ lb o - 7 ? f B % M

L1BL&. )

2. Numbers should be in Arabic figures. (&+baB m @ M r, 1 6 r to )

3. Year should be written in the Anno Domini system. (.&96tBx-C i!5@ t 3 r )

4. Proper nouns should be written in full, and not be abbreviated. (B8&ml$-6^r~EStd%%k L. -tnt

f t ~ t ~ ~ ~ r k .

5. Enter below, the address for notifying the result of the selection /acceptance. ( 3 + & f ~ 8 l i b % u ) ~ t $ %g

d

Name:

t

Mailing address: %

Phone: Fax.: E-mail: , --

* Name of the desired supervisor (%SSPB*&lk W $5 ) Name: . . .

Prospective applicants are advised to get in touch with a potential thesis advisor at the University of

the Ryukyus for consultation on research themes and plan; applicants without advisor's such prior

approval may not receive full consideration during the admission screening.

T + f f t ~ S & ~ k 37% < r 2. $~~~~B&D!!%LI#~B*CE~;+

wr:td D ZT.)

* Please check if the following document are completed. (f;EcnP$&!~f& -, T G 1 a t ~ i 2 i t ~ b @ @ % ' 6 b t t: . ) Application form (From I - 1, 1 -2, 1 -3) Health Certificate (Form TI ) Certificate of Graduation or Certified Letter fiom the Graduate School

Transcripts of academic record Certificate of Citizenship or Proof of Residence

A letter of recommendation (Form Dl)

O A TOEFL SCORE for applicants whose 'instructional language at the home institution is not English.

A certificate indicating the medium instruction is English for applicants whose instructional language

is English.

An abstract of the Master's thesis or project.

Guarantee (Forrnw) for those who apply for non-scholarship program or both scholarship and

non-scholarship program.

Entrance Examination Fee,(30,000 yen) for non-scholarship applicants.

0 Certificate of Guaranteed Admission

Form 1-1

Bkinawa International Marine Science Program* Graduate School of Engineering and Science

University of the Ryukyus

(Doctoral Program)

1. Name in full, in native language [&a(($ HS)]

(Family name) (First name) (Middle name) In Roman block capitals (a -7%)

-.. (Family name) (First name) (Middle name)

2. Nationality (El%)

Paste your passport photograph taken within the past 6 months. Write your name and nationality in block letters on the back of the photo, 6 cm X 4 cm in size.

I

(Sex) wale (93)

El Female (k)

(Marital Status) Cl Single (%B) U n4arried(E@)

3 . ~ a t e o f b i r t h ( $ q H E l ) Year19 .Month . Dav . Arre (As of April 1,2007) (&I (8) (El) (&@2007&4HlEl%E)

4. Present status; with the name of the univmity attended, or of the employer.

5. Present address and telephone number, hcsimile number, E-mail adclress. (R&FJiBrn, 7 7 Y /I ~%-4, E %-)by F kX)

Office: Address:

Phone: Fax-: - . I : - -

Home: Address: - - --- Phone: Fax.: E-mail:

6. AppIication far Admission and Scholarship:

a Government Scholarship: Applying for admission with Japanese Government (Monbukagakusho) Scholarship

administered by the Graduate School of Engineaing and Science, University of the Ryukyus.

W111 you apply for Admission without Monbukagakusho Scholarship, if you are not admitted as a

Monbukagakusho Scholarship Student?.

u Yes No

NonSchdanhip: Applying for admission with any other scholarship, financial support or privateexpense.

r(hc w r n is m of Ihc lnkmaliond Rimity G h t e ~mgmms (PGP) oflapuse &-.

7. Field of study specialized in the past: Describe in detail and as concretely as possible.

css,t:mLt~am%e, ~~;atr"c3-~~fsfit~rnt~a< r 2.)

* In case the blank spaces above are not &cient for infortnation req& please attach additional sheets to this fom kfSlt:/$$tU'b~~4%ti:kL. ~%QWJ@kizZh ~ 7 a t ' b a t 2. )

Diploma or degree awarded (?w-B#)

Major subject (6&RH)

8. Educational background (%!@) Namedaddress of school (%Em=)

Paiod of schooling you have attanded cwwk,

yrs (Q)

yrs (Q)

yrs (%)

yrs (el r

Year and month of amance and completim (A*WWSPFFl)

From (A*)

To (@%)

From (A*)

To ($;%)

From (A*)

To (9%)

From (A*)

To (9%)

~Frn ( AY)

Name (We)

Location (iJiEE@)

,. Name (YR.%)

&cation c a i ~ )

Name (&%)

Location (ai%&)

Name tW@)

Location (%#I!.!)

Name (942%)

Elementary Educaticn (-)

Elementary School ( ~ I \ * r n

To ($1)

(HIE)

Total number of

Secondary Education (EPm

secondary School C + Q R ~ W ~

(9%

Upper

(*@)

Higher Education (i%6al$)

Undergraduate Level (A%)

Graduate level

Location (Rif~tt!!)

years of schooling mentioned above.

yrs t~

(u:Ak&%ffLf:eYm~~*t) me)

9. State the titles or subjects of books or papers (including graduation thesis authored by the ayplicant) , if any,

with the name and address of publisher and the date of publication.

(SS, P*, ((ab~f(e%itr) -hf&bIb3?@!@%, ttlRa%, El%i$fi 8 , ttlEl&QZAba Z &.)

* Accompany this frmn with a summary of the papers mentioned above ( m*Q)m9w[O t. )

10. Language proficiency: Evaluate your Id and mark with ( ' ) where appropriate in the following categories. (9l. e b m j i i , aMi=SPlkBWBbz 2.1

1 1 . Employment Record: Begin with the most rtxehkkmployment, if applicable (iM@ I Name and address of I Period of edoyment 1 Position I Type of work

Eqw(=)

- -

From

Excellent (#@

organhtion (mmm-)

To From

12. Family background (SBtMi) M

~~~d (a)

(m%#~trl) From

To

Poor (Ff;'iil)

occupation (IRD44)

(Eta%)

Name (E€%) Living or Deceased (*El

(rnrtJQ)

Relati* m)

*Check for a-mpany;lg dependents to Japan (a) gaq5m, r;;l# FB@f B l ~ # f %W

* All expenses incurred by presence of dependents must be borne by the pntee. He or she is advised to take

into consideration the various diEculties and large expense that will be involved in finding living quarters for

them Therefore those who want to accompany their fhihes are well advised to come alone first and let them

come after a suitable accommodation bas been found.

13. Is there anyone in your M y who has been awarded or applying for the Japanese Government Scholarship ?

If yes, please give his I her name.

( t ~ o r ~ r = ~ g ~ ~ ~ r ~ ~ r n ~ ~ ~ ~ c ~ a ~ ~ 5 L t itea+cr,mrbjanb0 s L. ~jaftl;~%, T ~ ~ ~ ~ , K ~ Z A B Z L )

Name : (awarded / applying)

Relationship :

14. Have you been awarded the Japanese Government Scholarship in the past? If so, please give the period, the

name of the university, etc.

1 ) Yes, I have. (f ib) Period IJBIA4) :

Universi~.(.k%&%) :

2 No, I h2ik not. (~JL))

15. Person to be notified in applicant's home coufitry, in case of emergency. (R,aBgtcr>r;3Wail%X)

1 ) Name in 1 1 1 (Kg):

2 ) Address with telephone number, facsimile number, E-mail address: (i&p7i. l%P-R67 7 -7 3' x.

Present address (W&R):

Telephone /Facsimile number OEESR/FAX H )

B~nail address

3 ) Occupation(l %) :

4 ) Relationship (W\&-mA4%) :

16. Immigration Records to Japan (El *-a>ig:%tZi)

Date (8 Purpose (EAiiHm) --

From To From

Date of application (&?i38 FI 8 ):

Applicant's signature (~PZ;-t%):

Applicant's name (in Roman block capitals)

(*F#'$~E€%(D--~%) :

%&9%7j t rn%Etrn Field of Study and Study Program

Name in full, in native language

(Family name) (First name) (Middle name)

Nationality .- (BS)

Proposed study program in Japan (State the outline of your major field of study on this side and the

details of your study program on the backside of this sheet. This selection will be used as one of the

most impon%nt references for selection. Statements m.ust be typewritten or written in block letters.

Additional sheets of paper may be attached if necessary. In the case of preparation of research

proposal as separated sheets, the following guideline may be helpful: A4 sized paper, single sided,

single spaced, preferred font (body) =12 pt ~hes, total pages less than 5 pages including figures and

les.) .- .. - E I + P ~ w ~ w & ~ ~ : za~f~&aia, ~ 4 a P ~ h W + & t ~ a a ~ . asl~rssatlacoaae, ami:wrpe;ttia8lcl>

1 Field of studv (6R5fBf)

2 Studv propm in detail (HRWiBi : B#Il:&hif 5 z 2 .)

Oldnawa International Marine Science Program* Graduate School of Engineering and Science

University of the Ryukyus (Doctoral Program)

1. Name in full, in Roman block capitals [&kg 8Eh, tl --T%P%&]

(Family name) (First name) (Middle name)

Paste your passport photograph taken within the past 6 months. Write your name and nationality in block letters on the back of the photo, 6 X 4 cm in size.

. (Sex) ElMale (9) C Female (k)

2.Dateofbirth(!k%aB) Year19 -Month . Dav . Age (As of April 1,2007)

-a

3. Nationality (81)

4. Present address, telephone number and facsimile number, E-mail address.

( @%Ed7 7 9 5 5 1J S e , E-mail 7 F bX)

5. The iwitution you have graduated / will graduate. ($ % L ??, 5 5 L 1 C3qsf @a&.)

<

Institution (BB) year (Q) Month (8)

Conferred Degree : a) Bachelor Degree bpaster's Degree c) Doctoral Degree

(@B*i@) (%*I (ti$&)

6 . Fieldofstudy in Japan (B$T(r)%&%B)

7.lf you are applying for other scholarships, state the name of sponsor, duration, amount, etc.

(6 L B D % Y & G ~ & B L T L M % ~ ~ ~ ; , ?@%ijiJ, &B, &~%EZZAT.;5 LL )

8. Have you been awarded the Japanese Government (MExT) Scholarstup in the past ? If so,

please give the period , the name of the university , etc.

(a&rrtstRa~w:aH Z ~ L T : r t fir8jani. &at& L;C;X, -~-nm~e9, ~ ~ a t ~ ~ g , ~ g g ~ ~ t . ; 5 z 2, )

1 ) Yes,Ihave.(h.;5) Period ( f tB H):

University (A*% 3):

2 No, H have not. ( t ~ b )

*The program is one of the International Priority Graduate Programs (PGP) of Japanese Government.

D-8

#&B%% CERTIFICATE OF HEALTH (to be completed by the examining physician)

a ~,SXI~%SI: r v, e8sirtz~iat-r 6 : t: . Please fill out (FRINTAWE)in Japanese or English.

&4 0% Male El Name: 0% Female Date of Birth :

$amily name. ' First ni ame Middle name

FL% Age :

1 . &W& Physical Examinations

(1) & B P Height cm ' Weight kg

(2) L dm&! M#i 0% regular Blood pressure mrnhic - mmfHg Blood Type m] Puke Ole i r r e N ~

(3) #€ n. Eyesight : 1R) (L) &*BSrn.kS OiE* Mzmal

without glasses *blidnes 0W.XFimOaired

(4) B A UiEs normal Hearing : OET impr ivd

P Hi OE 'normal speech: a# f impaired

2 , tpsecoll$Ml:3c\r, mt: X a # f O@%%?eAL-r( E8ct. Xdff l&lo> El(rthEAt4z k ( 6 t i l UkROloB%l&&%.) Please describe the results o f pllysical and X-ray examinations of applicant's chest x-ray (X-ray taken more than 6 months prior to the cer t ib t ion is NOT valid).

M OiE n o d Cardiomepaly : El&, 8 impaired \

Describe the condition of itp$-t<~ung. I.. .

~ * d f l b b t & 3 Electmcard i iph :OiEs. normal aks impaired

3. Si?SiblRtP~li3% 6 Yes (Disease; . I, ) , Mseaae Treated at Present 0 No

4 . efks * P u t history : Please indicate with + or - and fill in the date of recovery

..... . . -is.. .... 0 ( . - 1 Malaria.. ) Other communicable disease. ..... 0 ( . . . ) ICidncy Diserse.. ... . . ) Heat Diserees.. .... O( . . ) m.:::::Ool : . 1 on.*ll ..... CIC . . p ~ w e i s ..... a( . .

mlu( Db& i n exhMlib'es. ..... 8 . . . )

Laboratary tests Un'dyskglluwse ( ), pmtein ( ) . occult Mood (

BSR :LC, WBC count : A m Sik, 0 anemia

Hemoglobin: ' &dl, GPT:

6 . WBcnFWQ~~-CT &kt. Pleaee dcecdbe your impmaion.

7. ~ f t # ~ c o ~ ~ , %I a &ProS!R)\bWRL~, W?%pJwNk1RI-f;bf KBri.lKH;i i 6 b a k l b b & t l ) ~ ? I n view of the applicant's histoty and the above findings. a ~t Vw obsmation hisher health status is adequate to pursue studies in Qpan ?

yes 0 no

e+l t 4 Date: Sigmture:

E M E ~ Physician's Name in Ptint:

TO : President

University of the Ryukyus

Recommendee

Full Name:

Date of Birth:

Nationality:

* English language proficiency: Please evaluate recommendee's level and fill in with

( ) where appropriate.

Date :

<

Reading (SitrEfi) Writing

(B<%h) Speaking (BTEh)

(month) (day) bear)

Recommender

Signatwe.

Excellent (MI

?.

Name:

Title and Institution (or Company):

Present Address :

Good (&I

Fair (q)

Form IV

G U A R A N T E E

tsi: 3 i To : President

University of the Ryukyus

Name of Student:

Date of Birth:

Nationality :

I shall be responsible guarantor for the good behavior of the above named while

enrolled in University of the Ryukyus,and Iguarantee his or her conduct and all the

educational expenses for him or her.In token of this pledge I a& my signature.

Guirantor

Signature:

Print Name:

Present address:

Phone:

~ccupation(in detail):

Name of office and Address: Phone:

Relationship with the Student (in detail):

Date of Guarantee:

* Note: A Japanese residing in Japan is preferred to be a guarantor.