Application for Admission (Programs Conducted in English)

To : President, Osaka University

Name in full :[in Roman Block Letters]

[in Chinese Characters]

Zip Code：E-mail ： TEL ：

Nationality/Region

(Year) (Month) (Day)

・Proper nouns should be written in full, not abbreviated.

Present Address

〈Notes〉

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

Entrance Application for October 2021 [Doctoral Degree Program]

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

・Specify your academic background and employment history in detail.

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

I hereby submit my application form for acceptance to the Graduate School of Engineering, Osaka University as a student of the Doctoral Course with [ ].

Photo（4 cm × 3 cm）

*Please writeyour name onthe backsidebefore pasting.

Date of Birth

PermanentAddress in

Home Country

Student ID Number(If you are presently enrolled

in Osaka Univ.)

Sex Male Female

[in Katakana]

TEL

TEL

E-mail

RelationshipName Address

Person (living in Home Country) to be notified in case of emergency

Person (living in Japan) or prospective supervisor to be notified in case of emergency

Name Relationship Address

E-mail

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(for Students who expect to complete Master's Degree program of Graduate School of Engineering, Osaka University)Choose one of the programs which you wish to enroll. [ ]

*Applicants to “International Priority Graduate Program on Applied and Engineering Physics” MUST ask their supervisors which course they should apply for.

Educational Background

Numbersof Years

From /

To/ years years

From/

To/ years years

From/

To/ years years

From Bachelor/ Master

To Other/ years ( years

From Bachelor/ Master

To Other/ years years

years years

years

From To

/ ～ /

From To

/ ～ /

Lower and Upper Secondary School

Classification

Elementary School

State any experience of studying abroad in countries (including Japan) other than your home country.

Graduate Level

School and Faculty Period of Attendance(yyyy/mm) Details

Research Student

Attach a proof of enrollment if you are NOT a research student in Osaka University.

If you have ever taken "Japanese Language Proficiency Test" or "Examination for Japanese University Admission for International Students," attach a copy of your results.

Others

Undergraduate Level

Japanese Language School

Name of School

Address of School (City, Country)

Total Years of Schooling Mentioned Above

Period of Attendance RequiredYears of

Study

Degree(Bachelor/

Master)(yyyy/mm)

(

( (

Employment HistoryPeriod of Emplyoment

(yyyy/mm)

～

Name and Address ofOrganization Position Type of Work

～

～

- 2 -

Research Interests (after enrollment)

Research Achievements

(List your research papers and publications, if any. Specify the title, name and address of publisher,

and date of publication of each paper. If you don't have any, specify what you have learned so far.)

Prospective supervisor: whom you have contacted and obtained permission to apply.

Japanese Language Proficiency : Self-evaluation. Check one that applies.GoodExcellent Notes

ReadingWriting

Fair Poor

Speaking

Fair PoorEnglish

Language Proficiency : Self-evaluation. Check one that applies.NotesGoodExcellent

Listening

- 3 -

[Programs Conducted in English]

Program Name

Examinee's number

Name :

[Programs Conducted in English]

*Do not fill in.

Graduate School of Engineering, Osaka University Keep this ticket until admission to Doctoral program. *Do not fill in.

Graduate School of Engineering, Osaka University

Photo Card (2021) For Year 2021

Admission for October 2021

Admission Ticket for Examination (2021) For Year 2021

Photo(4 cm × 3 cm)

*

Program Name

Examinee's number

Name : Photo(4 cm × 3 cm)

*

*No need to submit if you live abroad.

Doctoral Program

Admission for October 2021 Doctoral Program