Microsoft Word - IMAC-G Application Form 2016oct.doc

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1 Photo (5cm high 4cm wide) must show upper body, facing front With no hat, have been taken within three of application. 志望専攻専攻受験記号番号 * Please DO NOT fill in the above blanks In A4 sized (21cm 29.5cm) printing FORM (1/6) 2016 Academic Year APPLICATION FOR AUTUMN ENROLLMENT IN INTERNATIONAL GRADUATE PROGRAMS IN ENGINEERING INTERNATIONAL MECHANICAL AND AEROSPACE ENGINEERING COURSE (IMAC-G) 平成 28 年度国際機械工学コース入学願書 (October 2016 enrollment) ( 平成 28 年 10 月入学 ) INSTRUCTIONS( 記入上の注意 ) 1.The application should be typed if possible, or neatly hwritten in block letters.( 明瞭に記入すること ) 2.Numbers should be in Arabic numerals.( 数字は算用数字を用いること ) 3.Years should be written using the Anno Domini system.( 年号はすべて西暦とすること ) 4.Proper nouns should be written in full not abbreviated.( 固有名詞はすべて正式な名称とし, 一切省略しないこと ) Master s Degree Program( 博士課程前期 2 年の課程 ) Doctoral Degree Program( 博士課程後期 3 年の課程 ) 1. in full in native language, ( 姓名 ( 自国語 )) (Family name) (First name) (Middle name) (Gender) Male( 男 ) Female( 女 ) In Roman block capitals, (ローマ字 ) (Family name) (First name) (Middle name) 2. Nationality ( 国籍 ) 3. Date of birth( 生年月日 ) Year Month Day( 日 ) Age ( as of October 1,2016) 年齢 (2016 年 10 月 1 日現在 ) 4. Department supervisor to which you wish to apply( 志望専攻名受入 ( 希望 ) 教員名 ) Department of / Prof. Associate Prof. *You should contact the supervisor of your choice before applying. 5. Desired examination venue ( 希望受験地 ) Country( 国 ): City( 都市 ): *The school will designate where to hold examinations in consideration of the applicant s place of residence specified in this Application Form, as well as the number of applicants from each country. hoku University does not guarantee the availability of examinations outside of Japan. ( 受験地は願書に記載された志願者の居住国およびその国からの出願者数等を考慮し当校で指定しますこれは日本国外における入学試験実施を保障するものではありません )

5cm) printing FORM (1/6) 2016 Academic Year APPLICATION FOR AUTUMN ENROLLMENT IN INTERNATIONAL GRADUATE PROGRAMS IN ENGINEERING INTERNATIONAL MECHANICAL AND AEROSPACE ENGINEERING COURSE (IMAC-G) 平成

2 FORM (2/6) 6. Present address telephone number, facsimile number, address ( 現住所及び電話,ファックス番号,E mail アドレス) 現住所 (Present address): 電話番号 /FAX 番号 (Telephone/facsimile number): address: 7. The institution from which you have graduated / will graduate.( 卒業した,あるいは卒業予定の機関 ) Institution( 機関 ) Year Month 8. Educational background( 学歴 ) Elementary Education ( 初等教育 ) Elementary School ( 小学校 ) Address of School ( 学校名及び所在地 ) Year Month of Entrance Completion ( 入学及び卒業年月 ) Period spent at the school attended ( 修学年数 ) Diploma or Degree awarded, Major ( 学位資格, 専攻科目 ) Secondary Education ( 中等教育 ) Lower Secondary School ( 中学 ) Upper Secondary School ( 高校 ) Higher Education ( 高等教育 ) Undergraduate Level ( 大学 ) Graduate Level ( 大学院 ) tal of schooling stated above ( 以上を通算した全学校教育修学年数 ) as of October 1, 2016 (2016 年 10 月 1 日現在 ) *If the space is not sufficient for the information required, please use a separate sheet attach it to this document. (( 注 ) 上欄に書ききれない場合には, 適当な別紙に記入して添付すること )

The institution from which you have graduated / will graduate.( 卒業した,あるいは卒業予定の機関 ) Institution( 機関 ) Year Month 8.

3 FORM (3/6) 9. State the titles or subjects of books or papers (including graduation thesis authored by the applicant), if any, with the name address of the publisher the date of publication. ( 著書, 論文,( 卒業論文を含む )があればその題名, 出版社名, 出版年月日, 出版場所を記すこと ) *Please attach abstracts of those papers to this application.(( 注 ) 論文の概要を添付のこと 10. Employment Record: Begin with most recent employment, if applicable.( 職歴 ) address of organization ( 勤務先及び所在地 ) Period of employment ( 勤務期間 ) Position ( 役職名 ) Type of work ( 職務内容 ) * I swear the above is a true statement ( 上記のとおり相違ありません) Date of application: ( 申請年月日 ) Applicant's signature: ( 申請者署名 ) Applicant's name (In Roman block capitals): ( 申請者氏名 )

Employment Record: Begin with most recent employment, if applicable.

4 FORM (4/6) Department Head of the Division of Mechanical Engineering Letter of Acceptance 1. Department of the applicant s preference: 2. of the applicant: I agree to supervise the above applicant when the applicant passes the entrance examination of IMAC-G. Date: of professor (Print): Signature: The supervisor who supervise the above applicant needs to fill in the following question about security export control. ( 安全保障輸出管理に関する下記の質問に, 受入れを予定している指導教員が記入してください ) The check about security export control ( 安全保障輸出管理に関する確認 ) 志願者が外国人であるため, 基本フロー図及び留学生外国人研究生受入れチェックフロー図 ( )に基づき, 以下のとおり確認を行いました受入れ予定教員 ( 所属氏名 ) 印承認済み( 既に輸出管理シートにより判定手続を完了し, 承認を得ている ) 承認日 : 月日承認部局 : 手続不要 ( 基本フロー図及び留学生外国人研究生受入れチェックフロー図により, 判定手続きが不要であることを確認した現時点では手続きが完了していないが, 試験日までには完了する見込みである ( : 東北大学における安全保障輸出管理 HP

Date: of professor (Print): Signature: The supervisor who supervise the above applicant needs to fill in the following question about security export control.

5 FORM (5/6) Selection vote of the oral examination Questions on mathematics two special subjects will be asked. Choose two subjects from the following subjects, Choose two subjects from the following subjects, (1) Thermodynamics, (2) Fluid Dynamics, (3) Strength of Materials, (4)Dynamics of Mechanical Systems, (5) Control Engineering, (6) Materials Science, (7) Electromagnetics, (8) Quantum Mechanics. Please fill in a subject, which you want to choose two special subjects. 1 2 Examination admission ticket IMAC-G Master s Degree Program Entrance Exam. ID-No. Doctoral Degree Program * Please DO NOT fill in the above blanks OCTOBER 2016 ENROLLMENT IN INTERNATIONAL GRADUATE PROGRAMS IN ENGINEERING INTERNATIONAL MECHANICAL AND AEROSPACE ENGINEERING COURSE (IMAC-G) in full, (English) (Family name) (First name) (Middle name) Nationality (Gender) Male Female Department supervisor to which you wish to apply Department of Prof. Associate Prof. Note1: After you apply, this Exam admission ticket will be sent back to you. Be sure to bring it with you on the exam day.( 出願後この受験票は返送されますので試験当日必ず持参してください ) Note2: Notification of Success in the exam will be announced by the examinee' number on the ticket. So please keep it until the day of publishment for the exam result. ( 受験票上の受験番号は合格発表時に利用します受験票は合格発表時まで大切に保管してください )

(5) Control Engineering, (6) Materials Science, (7) Electromagnetics, (8) Quantum Mechanics. Please fill in a subject, which you want to choose two special subjects.

6 FORM (6/6) Address Labels( 受験票, 合否通知書, 及び受験許可書 ( 受験ビザ取得のため)を送付するための宛名ラベル) Fill in the receiver s name address on the following labels. * For sending the Examination Admission Ticket : Address: (Examination Admission Ticket ) * For sending the Notification of Result : Address: (Notification of Result) [if applicable] ( 該当する場合 ) (Notification of Result) * For sending the Examination Permit for acquiring Temporary Visitor VISA (for examination) : Address: (Examination permit) Note: Acquiring VISA for Examination (Temporary Visitor VISA) Applicants who live outside Japan for Master s Program in Graduate School of Engineering, hoku University need to acquire Temporary Visitor VISA (for examination) should get examination permit which our university issue after we receive your application. Those desiring us to issue Examination Permit should include a request letter (any format) send the letter with application documents. Additionally, it is necessary to send a photo (5cm long 4cm wide) aside from the photo for photo ID. Please write down department name of your choice your name on the reverse side of the photo. (Mailing Address: See 13. Contact Information.)

(Notification of Result) * For sending the Examination Permit for acquiring Temporary Visitor VISA (for examination) : Address: (Examination permit) Note: Acquiring VISA for Examination (Temporary

7.Preferences( 志望先 ) Department( 専攻名 ) Preferred academic advisor( 希望する指導教員 ) Date of contact with preferred academic advisor( 希望する指導教

7.Preferences( 志望先 ) Department( 専攻名 ) Preferred academic advisor( 希望する指導教員 ) Date of contact with preferred academic advisor( 希望する指導教 October 2016 Admittance Application Form Special Selection Prior to Arrival in Japan Doctoral Program, Yokohama National University Graduate School of Environment and Information Sciences 2016 年 10 月入