1-1 (Form#1-1)

April Entrance

2016

Application for Doctoral Program (Doctor in Engineering/Science)

Graduate School of Science and Engineering, Ehime University
(To: The President of Ehime University)

(Dear Sir: To get admission into the Doctoral Program (Doctor in

Engineering/Science) of the Graduate School of Science and Engineering of your university, I
hereby apply and request for the admission through necessary selection procedure.)

Selection
Category

Selection of International Students

Major (or special

course) applied
for

Registration

No.

Course (or

division) applied

for

Full Name

(Family name)

(Given name/s)

Full name of
the proposed
Supervisor

Date
Of
Birth

//
(yyyy/mm/dd)

()
(Age: ...)

Sex

(M)

(F)

Nationality

Bachelor degree obtained from . University (),

Faculty of ..... (), Department of . ()

University or
College of
graduation

in (year) ..(month)
Master degree obtained/expected from .. University (),
Graduate School (or Faculty) of ....(), in the field of .
... () in .(year) ..(month)

Affiliation or
Profession

Present Address
(Tel:

(Tel:

Mailing Address

Note: Do not write in the cell with mark.

In case of applying for special course, write division in the cell with mark.
1-2 (Form# 1-2)

Academic/Professional Details and Achievements

Details (Name of College/University, major field of study, etc.)

Details (Name of organization, position held, etc.)

(yyyy/mm)

Education
Background

(From Elementary
School ; in
chronological order
of admission and
graduation)

(yyyy/mm)

Professional
Background
(list in order of
previous to
recent)

Qualification/s

Prizes and
Punishments

(Note: Please provide the above information in detail, as far as possible.)

 1-2 (Form#1-2)

April Entrance
2016

Doctoral Program (Doctor in

Engineering/Science)
Graduate School of Science and
Engineering, Ehime University

April Entrance
2016

Doctoral Program (Doctor in

Engineering/Science)
Graduate School of Science and
Engineering, Ehime University

Personal Identification
Card

Entrance Test Admission

Card

Selection
Category

Selection of International
Students

Selection
Category

Selection of International
Students

Registration
No.

Registration
No.

Major (or
special course)
applied for

Course(or
division)
applied for

Major (or
special course)
applied for

Course(or
division)
applied for

*
.

Full Name

Full Name

(Family Name) (Given name/s)

Date of Birth

Nationality

//
(yyyy/mm/dd)

Sex

*
.

(Family Name) (Given name/s)

Date of Birth

Nationality

//
(yyyy/mm/dd)

Sex

Photograph

Please paste your

pp-size (4cm x 3cm)
photo (taken within
the last three
months) here.

Note

(Carry this admission card throughout the time of

selection test.)

Do not enter text in the cell with this mark Do not enter text in the cell with this mark
In case of applying for special course, write
In case of applying for special course, write
division in the cell with mark.
division in the cell with mark.

 2 (Form#2)
(page) 1/.

Summary of Master Thesis
. University ,
Grad. School or Faculty of

University/
College

Full Name

...... ,

Admitted:
....
Graduated:
....

in the field of..

Thesis Title

Supervisors
full name

Prof.

Date of
submission

()

Do not enter text in the cell with this mark

.....
(Y) (M) (D)

(page) 1/.

Summary of Master Thesis

Do not enter text in the cell with this mark

 3 (Form#3)
(page) 1/.

Outline of Master Thesis Research
. University ,
Grad. School or Faculty of

University/
College of
enrollment

Full Name

Admitted:
....

Expected
graduation:

......,
in the field of..

.....

Research
Title

Supervisors
full name

Prof.

()

(Scheduled)
Date of submission

Do not enter text in the cell with this mark

.....
(Y) (M) (D)

(page) 2/.

Outline of Master Thesis Research

Do not enter text in the cell with this mark

 (Form#4)

Research Plan

Full Name

Remarks

Registration No.

Research theme

Do not enter text in the cell with this mark

(Form#5)

Registration
No.

Permission to appear in Entrance Test

:
(Full Name)

Date of Birth ......

(The above applicant to the Doctoral Program of the Graduate School of Science and
Engineering, Ehime University for Academic Year 2016 is permitted to appear in the
Entrance Test.)

(year) (month) (day)

To: The Dean

Graduate School of Science and Engineering
Ehime University

(Address)

(Affiliation)

(Head)
(Signature/Seal)

Do not enter text in the cell with this mark

-1 (Form#6-1)

Research Activity Description (Part 1)
2016

Full
Name
Note 1.
Master thesis title

Job duration

Major

(or

special

course) applied for

Course (or division)

applied for

Job place

Reg.
No.

Major job experience details

10

1,000
Past job description related to the research plan (about 250 words)

Note: If you do not have a master thesis, leave this cell blank.

Do not write in the cell/s with mark.

3. In case of applying for special course, write division in the cell with mark.

Research Activity Description (Part 2)

-2 (Form#6-2)

(Full Name):

Major
special

(or
course)

Course (or division)

applied for

applied for

Major publications (e.g., Journal papers, research
reports, patent/s, etc.)

Date of
publication

11

Reg. No.

Publisher, Name of
Journal or Society

Remarks (Coauthors)

(Please enter the total number below.)

(Journal papers:.., Research reports: , Patent: ..)

Note Enter your publication list in chronological order (recent first). Also, please use separate sheets
(photocopy possible) for the journal publications, conference/seminar papers or presentations, patent
registration, etc.

Do not write in the cell with mark.

3. In case of applying for special course, write division in the cell with mark.

12

 7 (Form#7)
April Entrance

Doctoral Program (Doctor in Engineering/Science)

Graduate School of Science and Engineering, Ehime University

Admission Eligibility Assessment Sheet

Selection
Category

Selection of International
Students

Sex

(M)

(F)

Full Name

Date of Birth
(Age)

Nationality

Present
Address and
Tel No.

.(Y)(M).(D)
. (years old)

(Academic Record)

Year/Month

(Details)

(Professional Record)

Year/Month

Year/Month

Major applied
for (or special
course)

Full name of
the proposed
Supervisor

(Details)

(Professional and Societal Activities)

Year/Month

(Details)

(Awards)
(Details)

The above details are true.

Date: ..//..

Full Name: (Signature) .

Note: In case of applying for special course, write division in the cell with mark.
13