APPLICATION FORM TO GRADUATE PROGRAM

for October 2017 Intake

Department of Civil Engineering, Yokohama National University
Note to Applicant: This application form consists of five pages. Type or print clearly. This
form must be submitted with other necessary documents.
1.Program applied: Doctoral program Master program
2.Field of study applied: Civil engineering
3.Name in full in native language ,
(Surname)
(Given name (Middle name)
In Roman block capitals
,
(Surname)
(Given name (Middle name)
(Please write your name exactly as it appears in your passport.)
4.Nationality:
4.-1Japanese nationality
Yes, I have.
No, I dontAttach
have it.
a

recent photograph here

5. Sex: male female
6. Marital status: single married
7. Date of birth:

8. Age (as of April 1, 2017):

9. Mailing address (Give address where you are surely contacted until October 2017.
If you plan to move, give present address and future address and show valid period.):
Present address:
Telephone number:
Facsimile number (if available):
E-mail address:
10.Field of specialization studied in the pastBe as detailed and specific as possible.)

11. Academic Background:

Name and Address of School Year and Month
of Entrance and

Completion

Duration of
Attendance

Diploma or Degree
Awarded, Major Subject,
Skipped Years/Levels

Name

From

y
ears

Location

To

and

mont
hs

Name

From

y
ears

Location

To

and

mont
hs

Name

From

y
ears

Location

To

and

mont
hs

Name

From

y
ears

Location

To

and

mont
hs

Name

From

y
ears

Location

To

and

mont
hs

Primary Education
Elementary School

Secondary Education
Middle School

High School

*-1

Tertiary Education
Undergraduate Level

Graduate Level

Total number of years of the aforementioned

schooling
*as of April 1, 2017
Notes:

years

Exclude kindergarten education and nursery school education.

Preparatory education for university admission is included in secondary education.
If the applicant has passed the university entrance qualification examinations, indicate this in the column with *-1.
Any school years or levels skipped should be indicated in the fourth column (Diploma or Degree Awarded, Major Subject, Skipped
Years/Levels). (Example: Graduated high school in 2 years.)
If you attended multiple schools at the same level of education due to moving house or readmission to university, then write the schools in
the same column and include the number of years of study and current status for each school.
. Calculate and write the total number of years studied based on duration as a student. (including extended leave such as summer vacation)
. You may use a separate piece of paper if the above space is insufficient. In such a case, please stipulate that the information is on a
separate page.

12. State the titles or subjects of books or papers (including graduation thesis authored by the
applicant), if any, with the name and address of the publisher and the date of publication.

13. Employment record (Write employed period, employers name, job title and job

description. Start with the most recent employment.):

period

employers name

job title and description

14. Other professional experiences if any:

15. Present status:
16. Field of interest (Select one of them.)

1. Structural
2. Estuarine and Coastal
3. Geotechnical
4. Transportation and Urban
5. Concrete
17. Field of interest in detail and study plan at Yokohama National University:
Use separate sheet and attach to this form.
18. Future plan after completion of the program:

19. Name of two persons who write recommendation letter for you. (Two recommendation
letters in specific form should be sent directly to the Department.)
(1)

name

title

institution

name

title

institution

(2)
20. List of other graduate schools you are applying to:

21. Will you surely be able to come to Japan in October 2017?

Yes No (explain reason.)
22. Japanese language proficiency: Evaluate your level and insert an X where appropriate in the
following blank space.
Excellent
Good
Fair
Poor
Reading
Writing
Speaking

23. Language ability: Evaluate your level and insert an X where appropriate in the following blank
space.

Poor
Excellent
Good
Fair
English
French
German
Spanish

24. Past awarded record

Have you been awarded a Japanese Government (Monbukagakusho) Scholarship in the
past? Please check ) or) below. If so, please specify the period, the name of the
university, etc.
) Yes, I have.
Period:
University:
) No, I have not.
25. Accompanying Dependents (Provide the following information if you plan to bring any
family members to Japan.)
* All expenses incurred by the presence of dependents must be borne by the grantee.
He/She is advised to take into consideration various difficulties and the great expense
that will be involved in finding living quarters. Therefore, those who wish to be
accompanied by their families are advised to come alone first and let their dependents
come after suitable accommodation has been found.
Name

Relationship

26. Person to be notified in applicant's home country in case of emergency

Name in full:
Address with telephone/facsimile number, and email address.
Present Address
Telephone/facsimile number
E-mail address
Occupation:
Relationship to applicant:
27. Immigration Records to Japan
Date

Purpose

Age

From
To
From
To
28. I certify that I have read all instructions and that information in this application is true and
complete. I understand that misrepresentation may be cause for canceling my admission. I
understand that all credentials and documents I submit become the property of Yokohama
National University.

signature of applicant

date