E J

Be sure to send your application via tracked service, such as resigtered mail (i.e. EMS, , Letter Pack)If you are unable to submit some documents by the dealine, or plan to submit documents afterwords, please include a memo

noting which documents are not included and when you plan to submit them.

(Your estimated) Submission Deadline for the extra documents

Student No. Laboratory Ext.

Adviser's Signature and Seal

N a m e

Address in Japan

(enrollment year)

Master's course Doctral course Medicine Dentisitry

Graduate school

Undergraduate

Faculty

N a m e Student Number

Family members living together in Japan only

Instruction for Completing Admission Fee Waiver Application Form (Example)

The application for Admission Fee Waiver will be used only for the screening procedure for Admission fee waiver. Indicate the truth accurately by yourself.If intentional descriptions different from the fact are found, the Admission fee waiver will be canceled even after the approval.

Fill in the situation as of April for the April enrollment and as of October for the October enrollment.

For the items marked with , encircle the appropriate items.

Fill in the column of "Reasons for Difficulty in Admission Fee Payment" including the following items.

Special circumstances

Independent livelihood financial situation

Situation of persons (living in Japan) under long-term medical treatment

Detailed situation (in Japan) of storm and flood damage, etc.

Foreign students' life situation in Japan

When you are unemployed, indicate how you cover your cost of living, the prospect of reemployment, etc.

Date of submission of application documents.

To be signed by the applicants

Attach the required documents.

Fill in the address, phone number, e-mail address that will be applicable after the application. Leave them blank if you don't know them at the time of application.

Leave the student No. blank if you don't know your new student No. at the time of application.

To be signed by adviser. Signed or sealed by proxy are not acceptable.

Please use blue or black pen only (pencil and erasable pen are not acceptable).

Student No. Laboratory Ext.

Adviser's Signature and Seal

N a m e

Address in Japan

(enrollment year)

Master's course Doctral course Medicine Dentisitry

Graduate school

Undergraduate

Faculty

Instruction for Completing Admission Fee Waiver Application Form

N a m e Student Number

Family members living together in Japan only

Occupation of family members living together in Japan

If you or family member(s) living together in Japan have the Identification booklet for the physically disabled certificate, fill in the name and level.If you or family member(s) living together in Japan are on long-term medical treatment, fill in the name and submit the most recent six months of receipt of medical treatment.

Enter the necessary items so as to copy them in the duplicate sheet. Submit the sheets without separating them.

For the items marked with , encircle the appropriate items.

Do not fill in the items inside the thick line frame. These items are the official use only.

Scholarship benefits to be received (expected to be received) during this academic year (from this April to next March).Fill in the name of the scholarship.

Foreign students paying their own tuition must fill in the information about ONLY family members living

Left-align the Student No

This is for Japanese students only

Foreign students paying their own tuition must choose 1.

Please use blue or black pen only (pencil and erasable pen are not acceptable).

Official Use Only

Official Use Only

Official Use Only

Family members (living together in Japan) enrolled in school as of April (April enrollment) and as of October (October enrollment).

This is for Japanese students only

Form A

TOHOKU UniversityDocument for Admission / Tuition Fee Waiver Application

Student No.

NAME

E

TOHOKU University Document for Admission / Tuition Fee Waiver Application

Payment Slip Attachment Sheet

Name of the income earner

Relationship with the applicant

Type of Employment

/ Full-time employee Part-time employee Other

Student No

Name

Form 1

TOHOKU University Document for Admission / Tuition Fee Waiver Application

2020 1

/ (

3

3 3

(

)

12

2021 4 2022 3

Student No.

Name

This form must be filled out by the person in charge of the employment.

Form 5

To President,

I declare the following information to be factual and accurate.

Other Other

Total Total

Income

Occupation / School

Utilities

Fill out your financial situation as of April 2021 1st semester) or October 2021 (2nd semester).

Average Living Expensesper Month

Statement of the Financial Situation

Family members living in Japan

Surname Given name

Books, school supplies(excluding tuition fee)

Transportation andCommunication

Food

Expenditure

Important The balance between income and expenditure must be even or income must be more than expenditure.

TA/RA

Indicate the financial situation in Japan (calculated in Japanese yen) accurately.

Item

Housing(include management /

maintenance fee)

Scholarship(family member)

Scholarship (applicant)

Child Care

Insurance /Medical Care

Part-time work(family member)

Daily necessities

Part-time work(applicant)

Name

Adviser's remark:PC

Self-financed / Moneybrought from home

TOHOKU University Document forAdmission/Tuition Fee Waiver Application

Student ID Number

RelationshipLiving

together/separately

(seal)

ItemAverage Income per Month

Remittances / Financialsupport from family, etc.

(Adviser's Signature

Age

Form7 To be filled out by foreign students paying their own tuition

TOHOKU University Document for Admission/Tuition Fee Waiver Application

Statement for Accommodation Situation

Indicate your accommodation type

(International House/University House) (Public Housing) (Private Apartments/Houses) (Other)

(Rent per Month)

If the applicant is living in private apartment or public housing, please submit a copy of the contract of lease.

If the applicant is sharing a room, or does not have a contract of lease for his/her accommodation, please fill out the “Conditions of Lease Contract” below.

If the applicant does not pay rent, shares the rent with roommate or pays less than the full monthly rent, please describe the situation in the “Other Information”.

Conditions of Lease Contract of your Accommodation

Address

Lessee

Relationship with Applicants

( )

Person(s) living with Lessee other than

applicant

Yes ( Name Relationship with Lessee

No

Rent per Month

Include Common Area Fee

(Applicant’s share)

Other Information

Please submit a copy of the contract of lease (photocopy).

( ) I declare the above information to be factual and accurate. (Must be signed by the person who rent the apartment)

Lessee Signature

( ) Phone No.

Student Number

NName

11 Form 11

Tohoku University Document for Admission / Tuition Fee Waiver Application

TA RA Certificate of (expected) TA/RA Payment

This is to certify the applicant’s working condition and income situation of TA/RA. Please certify the facts as stated below.

TA RA AA

20 4 1 20 9 30 6 300,000

It is not necessary to submit this form when there are other documents that certify the entire information above.

This form must be filled out by the person, faculty or the office in charge of the employment.