1
Application for Admission to Doshisha University 2017
For applicants of International Science and Technology Course (ISTC) at
Graduate School of Science and Engineering / Graduate School of Life and Medical Sciences (Master’s Program)
1. Full legal name:
In your own language
Last/Family First/Given Middle
In alphabet
Last/Family First/Given Middle
In Japanese (write your name phonetically in Katakana)
Last/Family First/Given Middle
2. Country of citizenship: 3. Date of birth: / /
day month year
4. Gender:
□Female □Male5. Current address
(If different from permanent address):
Street address
Phone number
Email address
6. Permanent address:
Street address
Phone number
Email address
7. Status of residence
(if you are already in Japan):
Date of arrival / / Status of residence
day month year
Valid until / /
day month year
8. You are applying to ISTC at:
□Information and Computer Science Course, Graduate School of Science and Engineering □Electrical and Electronic Engineering Course, Graduate School of Science and Engineering □Mechanical Engineering Course, Graduate School of Science and Engineering
□Applied Chemistry Course, Graduate School of Science and Engineering □Science and Environment and Mathematical Modeling Course,
Graduate School of Science and Engineering □Medical Life Systems Course, Graduate School of Life and Medical Sciences
2
9. Intended period of study at Doshisha University:
□2 years from April 2017 to March 2019
□2 years from October 2017 to September 2019
□others from , , to , , .
day month year day month year
10. Educational background:
List, in chronological order, all the schools you attended and are attending, starting with elementary school.
Name of school Location (city, country)
Period of attendance
(month/year) Degree obtained
Elementary School
, to ,
month year month year
Jr. High School
, to ,
month year month year
High School , to ,
month year month year
College/ University *
, to ,
month year month year
Graduate School *
, to ,
month year month year
* For undergraduate/graduate schools, please state your Faculty, Department and Major.
Undergraduate: Faculty Department Major Graduate: Faculty Department Major
11. Your native language:
12. Proficiency in foreign languages other than English:
Japanese □Excellent □Good □Fair □Poor
Dates schooled/studied years from , to , .
month year month year
13. Experience of studying Japanese, if any:
Name of school Location
(city, country) Period of attendance (month/year) , to , , to , , to ,
3
14. Occupational experience:
List all of your work history.
Name of employer Occupation Location
(city, country) Period of employment (month/year) , to , , to , , to , , to ,
15. Military service:
□None □Completed (from , to , .) □Exempted
month year month year
□Will serve (expected from , to , .)
month year month year
16. List all family members of yours including married brothers and sisters:
Full legal name Relationship Age as of April 2017 Current street address
17. Contact person residing in Japan, if any:
Full legal name Relationship to the applicant Street address/Phone number Occupation
Work address/Phone number
By my signature, I certify that all the answers I have given on this application are complete and accurate to the best of my knowledge. I understand that falsification or omission of information or credentials may result in revocation of admission.
Signature
4
Letter of Recommendation
For applicants of International Science and Technology Course (ISTC) at
Graduate School of Science and Engineering / Graduate School of Life and Medical Sciences (Master’s Program)
Instructions for the applicant – Complete PART1, then provide this form to the recommender. PART 1 To be filled out by the applicant
Full legal name:
Last/Family First/Given Middle
Country of citizenship: Date of birth:
Current street address:
Graduate School and course applying to:
Signature:
Instructions for the recommender – The person named above is applying for graduate study at Doshisha University. We appreciate your evaluation of the applicant’s academic performance and potential and of his/her personal qualities. Any information you provide here will naturally be considered strictly confidential. Please enclose this form in a sealed envelope, write your signature over the sealed flap and return to the applicant.
PART 2 To be filled out by the recommender
Name: School/Organization, Position: Address: 1. How long and in what capacity have you known the applicant?
2. Describe the applicant’s ability and potential, personal character, and capacity to achieve at Doshisha University. If necessary please continue on the back.
3. If the applicant is your student, please assess the personal qualities of this applicant by checking the most appropriate box.
□Outstanding □Excellent □Good □Average □Below average
1
Plan of Study
For applicants of International Science and Technology Course (ISTC) at
Graduate School of Science and Engineering / Graduate School of Life and Medical Sciences (Master’s Program)
Please turn over and continue on the back. If necessary, print this form again for third and fourth pages. Describe your research plan including any prior related research you have worked on.
Graduate school and course you are applying to: Name:
2
Mailing Labels
For applicants of International Science and Technology Course (ISTC) at
Graduate School of Science and Engineering / Graduate School of Life and Medical Sciences (Master’s Program)
Please correctly write your name and an address (normally your current address) that you would like the documents to be sent. Fill all four labels.
Name: □Mr. □Ms.
Address1 (Room number, Building, Street):
Address2 (City, Region, State):
Address3 (Country):
Zip code:
Examinee’s number: *** leave blank ***
Name: □Mr. □Ms.
Address1 (Room number, Building, Street):
Address2 (City, Region, State):
Address3 (Country):
Zip code:
Examinee’s number: *** leave blank ***
Name: □Mr. □Ms.
Address1 (Room number, Building, Street):
Address2 (City, Region, State):
Address3 (Country):
Zip code:
Examinee’s number: *** leave blank ***
Name: □Mr. □Ms.
Address1 (Room number, Building, Street):
Address2 (City, Region, State):
Address3 (Country):
Zip code:
Examinee’s number: *** leave blank ***
Application Card for Course and Laboratory
Graduate School of Life and Medical Sciences (Master’s Program), Doshisha University
Examinee’s number ***leave blank*** Name
Your preference Course
*must be the same course chosen for No.8 on the Application for Admission to Doshisha University
Supervisor Field of study (laboratory)
First
Second
Third
Please refer to our website for information on laboratories and supervisors available.
http://istc.doshisha.ac.jp/en/faq/faq.html (please refer to the Q. Where is laboratory page? )
Note：
Graduate School of Life and Medical Sciences will make a comprehensive decision upon matching of a student and laboratory by application documents and other factors such as availability. There is a chance that you may be accepted to a laboratory other than your choice as a result.
Pasteboard for the Receipt of Remittance
For applicants of International Science and Technology Course (ISTC) at
Graduate School of Science and Engineering / Graduate School of Life and Medical Sciences (Master’s Program)
Applicant’s name:
Paste the following receipt which certifies the remittance of the application fee.
Remittance from inside Japan
The receipt of the remittance of the application fee (the prescribed form) bearing the authorization
of the financial institution at which the money was remitted must be pasted onto this form.
Remittance from outside Japan
By telegraphic transfer – the receipt of remittance bearing the seal or stamp of financial institution
at which the money was remitted or its copy.
By credit card –Submit printout of the “Result” page only. It’s not necessary to paste the printout
onto this sheet.
Payment of Application Fee 入学検定料の納入について 必ず3票 （A票～C票） に必要事項 （☆印欄） を記入のうえ、(A)票～(C)票を切り離さずに、金融機関 （ゆうちょ銀行は不可） の窓口から「電信 扱」で納入してください。 振込依頼書(A)に掲載の本学指定金融機関の本・支店から納入する場合の手数料は不要です。 納入後、振込金証明書(B)、領収証(C)に取扱金融機関収納印が押してあることを確認してください。 振込金証明書(B)は「振込金証明書」貼付用紙（本学所定用紙）に貼り付けて、出願書類とともに提出してください。 領収証(C)は本人が保管してください。 生命医科学研究科 生命医科学研究科 国際科学技術コース （本人控） 国際科学技術コース ２０１７年度 ２０１７年度 同志社大学入学検定料 同志社大学入学検定料
振込金証明書
領収証 （兼手数料） （納入者保管）金額 10,000円
￥1 0 0 0 0
☆ 上記の金額正に受け取りました。 <注意> ☆ ※ 円 9 9 0 1 3 0<This form can only be used by applicants residing in Japan> 日本国内から納入する場合のみ使用
1. 2. 3. 4.
Fill in the spaces with (☆) in the following (A) to (C). Do not separate them before remitting the application fee by telegraphic transfer from a bank (Japan Post Bank “Yucho Ginko” is not acceptable).
No transaction charge is necessary when the applicant remits from the (central) branches of the banks listed in “振込依頼 書(A)”.
Make sure the seals of the bank are on “振込金証明書(B)” and “領収証(C)” after remitting.
1. 2. 3. 4. 5.
Submit “振込金証明書(B)” to the university with other application materials after pasting it onto the “Pasteboard for the Receipt of the Remittance (prescribed form)”.
5. Keep the transaction receipt “領収証(C)” for your reference.
手数料 氏 名 ﾌﾘｶﾞﾅ 住 所 志 願 者 住 所 氏 名 年 月 日 ☆ （〒 ） 振込依頼人 （志願者） ☆
B
A
C
（大学提出用）金 額
振込日（西暦） ☆ 1.いったん納入された入学検定料は 返還いたしませんので、注意して ください。 2.この領収証は本人が保管してくだ さい。 ◎本証明書は「振込金証明書」添付用紙（本学所定用紙） に貼付けて出願書類とともに提出してください。 科目 ① 三菱東京UFJ銀行 京 都 支 店 依頼日（西暦） 年振 込 依 頼 書
２０１７年度 入学検定料 430560 ￥ 普通 （取扱金融機関保管） 各 票 の ☆ 印 欄 は 、 払 込 人 に お い て 記 載 し て く だ さ い 。 受 取 人 口座名 電信扱 取扱金融機関へのお願い 普通 ☆ 同 志 社 大 学 入 試 志願者住所 ☆〒 電信扱 手数料 日 月0
振込指定 4567890
通 貨 当 手 京都銀行 本店営業部 普通 303000 整理番号 志願者氏名 （カタカナで記入） おつり 方 ℡ （ ） － 左記4行の本・支店窓口では 手数料無料扱い 志願者氏名 ☆ 普通 京都支店 ※ 先 方 銀 行 ☆ ご 希 望 の 銀 行 に ○ 印 ④ ※ 出町支店 三井住友銀行 300006 金 額 ドウシシャダイガク ニュウシ みずほ銀行1 0
0
② ③ 取扱金融機関１
収納印 取扱金融機関2
収納印 取扱金融機関3
収納印 （ 振 り 込 み 後 志 願 者 切 り 離 し ） （金融機関切り離し） 1.太枠内を打電してく ださい。 整理番号、 氏名の順で、打 電し てください。 2.収納印を 票3ヶ所に必ず押印 のうえ、 票を 依頼人にお渡しくだ さい。 B C B C ACheck Sheet for Document Submission
For applicants of International Science and Technology Course (ISTC) at
Graduate School of Science and Engineering / Graduate School of Life and Medical Sciences (Master’s Program)
Applicant’s name:
You are applying to ISTC at:
□Information and Computer Science Course, Graduate School of Science and Engineering □Electrical and Electronic Engineering Course, Graduate School of Science and Engineering □Mechanical Engineering Course, Graduate School of Science and Engineering
□Applied Chemistry Course, Graduate School of Science and Engineering
□Science and Environment and Mathematical Modeling Course, Graduate School of Science and Engineering □Medical Life Systems Course, Graduate School of Life and Medical Sciences
□Biomedical Engineering and Biomedical Information Course, Graduate School of Life and Medical Sciences
Use this sheet for assistance to prepare application materials. Check “Enclosed” for each item as you
enclose it in the envelope. Do not forget to enclose this sheet at the end.
Application materials
Emblem of Doshisha here means that the form is prescribed.
Enclosed ✓
For office use only 1 Application for Admission to Doshisha University
*Paste one 4cm x 3cm photo
2 Certificate of Graduation or Certificate of Expected Graduation of highest academic attainment (Original Only)
3 Transcript or certificate of academic records (Original Only)
4 Letter of Recommendation *Number of letters necessary differs depending on applicants’ status (refer to the admission guide page 5)
5 Plan of Study
6 Document certifying English proficiency (Original Only)
7 Any one of photocopy of Residence Card, Certificate of Items Stated in Resident Resister or Photocopy of Passport
8 Mailing Labels
9 Application Card for Course and Laboratory
10 Pasteboard for the Receipt of Remittance or printout of the “Result” page if paid by credit card
11 One identification photograph (3x2.4cm) for student ID card, database of students admitted and so on
