E-Mail: kamata@fms.saitama-u.ac.jp
Form A
Attach your photo taken within the past six months |
Saitama University
Application for Admission to
The INTERNATIONAL GRADUATE PROGRAM on
Environmental Science and Infrastructure Engineering
1. Name:
Family name given name middle name
2. Nationality: 3. Sex: (male/female)
4. Age: 5. Date of Birth: 6. Marital Status: (single/married)
7. Present Affiliation and Position:
Employer or university position or status
8. Permanent Address:
9. Present Mailing Address:
Tel: Fax: Email:
10. Course of Interest:
( ) Environmental Science and Infrastructure Engineering
( ) Mechanical Engineering
( ) Mathematics, Electronics and Informatics
( ) BioScience
( ) Functional Materials Sciences
11. Major Fields of Interest:
(a) (b)
12. Desired Supervisors:
(a) (b)
13. Application for Admission and Scholarship:
( ) Applying for Admission with Scholarship by the International Graduate Program
( ) Applying for Admission only, and have already obtained scholarship or financial support
(Please specify scholarship obtained:
)
Monbukagakusho Scholarship through Japanese Embassy in home country: ( ) have
Applied.
( ) Applying for Admission only. Expenses are privately funded.
14. Professional Experience: (list starting with the most recent employment)
Current Annual Income (in US$)
| Employer | Position/Title | Period From to | Full Time (year) | Nature of Work |
| | | | | | |
| Total years of Full time job | years |
15. Educational Background:
(a) Bachelor’s Degree Major
University
Location Period: from to
Class Rank: Total Number of Students: Grade or G.P.A.
Awards, Honor, Scholarships received
(b) Master’s Degree Major
Institution
Location Period: from to
Class Rank: Total Number of Students: Grade or G.P.A.
Awards, Honor, Scholarships received
(c) Other Academic Training: Specialization
Institution
Location Period: from to
Class Rank: Total Number of Students: Grade or G.P.A.
Awards, Honor, Scholarships received
16. Rate your proficiency in the English language:
Reading ( ) poor ( ) average ( ) good ( ) excellent
Writing ( ) poor ( ) average ( ) good ( ) excellent
Speaking ( ) poor ( ) average ( ) good ( ) excellent
Listening ( ) poor ( ) average ( ) good ( ) excellent
Certificate of English Proficiency (TOEFL, IELTS or equivalent):
( ) TOEFL score date taken
( ) IELTS score date taken
( ) Others name of test:
score: date taken:
17. Other comments (interests, achievements, skills, publications) which might be important to your application
18. List other universities or graduate schools (in Japan or other countries) that you are also applying to:
19. Name two persons who can give us critical evaluation of your qualifications:
(a) Name
Position / Title
Organization
E-mail address
(b) Name
Position / Title
Organization
E-mail address
I , the undersigned, herewith certify that all of the above information is true and correct at the time of completion.
Signature: Date:
Form B
Foreign Researcher and Student Office, Graduate School of Science and Engineering
SAITAMA UNIVERSITY, Saitama 338-8570, JAPAN
LETTER OF RECOMMENDATION
| Note to the applicant: Application for admission requires recommendations from two persons well acquainted with your intellectual ability and personality. Fill in your name and give this form to the recommender. Name of Applicant: Nationality: |
Note to the recommender: Please complete this form, seal in an envelope and sign across the seal, and return to the applicant. This letter will be held in the strictest confidence, and we would value very much your critical evaluation of the intellectual ability and personality of the applicant with regard to pursuing advanced study and research. Thank you very much.
Name of recommender:
Position/Title:
Organization:
Address:
Email: Tel: Fax:
How long (years months) have you known the applicant?
Under what circumstances have you known the applicant?
How often have you observed him/her? ( ) Daily ( ) Weekly ( ) Monthly ( ) Rarely
In comparison with other students in the same field, how would you rate the applicant’s overall scholastic ability?
( ) Truly exceptional --- One of the best you have known.
( ) Outstanding --- Top 5%
( ) Excellent --- Top 10%
( ) Good --- Strong ability, but not in the top 10%
( ) Average --- Upper 50%
( ) Below average --- Lower 50%, but recommended
( ) Not recommended
Some gifted individuals may get mediocre scholastic records. In your opinion, is the applicant’s scholastic record an accurate index of his/her scholastic ability? ( ) yes ( ) no ( ) don’t know
If you answer ‘no’ please explain briefly:
Evaluate the applicant’s ability to work with others:
( ) Outstanding ( ) Good ( ) Average ( ) Poor
Evaluate the applicant’s English proficiency:
Writing ( ) Outstanding ( ) Good ( ) Average ( ) Poor
Speaking ( ) Outstanding ( ) Good ( ) Average ( ) Poor
Your overall evaluation of the applicant:
( ) Strongly recommended
( ) Recommended
( ) Recommended with reservation
( ) Not recommended
Additional Comments, if any:
Signature: Date:
Form C
Name of Applicant: Nationality:
Essay 1. Your Field of Study in the past:
(a) write in detail (at least 600 words) on separate papers as attached pages
(b) summarize (in less than 150 words) within the block space below
Essay 2. Your Proposed Plan of Study:
(a) write in detail (at least 600 words) on separate papers as attached pages
(b) summarize (in less than 150 words) within the block space below
Essay 3. In your opinion, what is the most important engineering (infrastructure or environmental related) issue that should be addressed in your local community. Justify your choice and envision a role for yourself.
(a) write in detail (at least 600 words) on separate papers as attached pages
(b) summarize (in less than 150 words) within the block space below
Form D
RESUME
1. Name: Nationality:
2. Date of Birth: Year Month Day Place of Birth:
3. Address:
4. Marital Status: (Married/Single) Spouse’s Name:
5. Educational Background:
| | Name and Address of School | Number of Years | Year/Month of Entrance and Completion | Major Subjects | Diploma or Degree Awarded |
| Junior High School | | years | From: To: | | |
| Senior High School | | years | From: To: | | |
| College (if any) | | years | From: To: | | |
| Undergraduate | | years | From: To: | | |
| Graduate | | years | From: To: | | |
| Total years of schooling mentioned above | years | | | |
6. Experience of your study in Japanese Language:
Name of School, Address, Date of Entrance and Date of Graduation
7. Work Experience:
Name of Organization, Address and From To
(1)
(2)
(3)
(4)
(5)
8. Past Entry into/Stay in Japan:
Date of Arrival, Date of Departure, Status and Purpose of Entry
(1)
(2)
(3)
(4)
(5).
9. Reason for study in Japan:
10. Plan after you return to your home country:
I , the undersigned, herewith certify that all of the above information is true and correct at the time of completion.
Year Month Day
Signature:
