APPLICATION FORM FOR ADMISSION (INTERNATIONAL MASTERS PROGRAM) THE GRADUATE SCHOOL OF ENGINEERING, KYUSHU UNIVERSITY (October, 2012)

Year
INSTRUCTIONS 1. 2. 3. Application should be typewritten or handwritten in Roman block capitals. Numbers should be in Arabic figures. Proper nouns should be written in full, and not be abbreviated.
Family name, First name, Middle name

Month

Day

Name in full, in native language Name in Roman block capitals Name in Japanese Katakana if you know Date of birth The applying program

Examine e's number Nationality

Family name, First name, Middle name

Family name, First name, Middle name

Sex Marital Status

Male Female Single Married )

Age, Year Month day

International Masters program in (

Expected supervisor if you contacted him/her

The score of TOEIC, TOEFL etc if you had (Date of Examination) The latest academic background

TOEI C TOEF L University

( (

) )

IELTS Cambrid ge ESOL Faculty

( (

) )

Department

Year
The title of graduation research or graduation thesis

Month

Day

graduated will graduate

Present address
Telephone number Cellular phone number E-mail address

Do not fill in at the blank marked Applicants who are the students of Kyushu University must fill in the student ID number between parentheses. ( ) Degree if applicable Major subject

Educational background:
Name and address of school Requisite years of schooling Year and month of entrance and completion Elementary education Elementary school School name Location yrs from to yrs and mons Period of schoolin g

Secondar Lower School name y education Location Secondar y School Upper School name Location

yrs

from to

yrs and mons

yrs

from to

yrs and mons

Higher education School name Undergraduate level Location

yrs

from to

yrs and mons

Current school year/grade

Total years of schooling

Employment record:
Name and address of Organization Period of Employment From To From To From To Position Type of Work

FINANCIAL SOURCES FOR YOUR LIVING AND STUDYING IN JAPAN Put the mark to the number of MEXT (Monbukagakusho) Scholarship corresponding division in the right box. 2Government Scholarship 3Privately financed

 COLLATION CARD
The applying program International Masters Program in Examinees number

Alma matter University Faculty Department

Name in Japanese Katakana Male Female Name in Roman block capitals

Paste your passportsize photograph taken within the past 6 months. Write your name and nationality in block letters on the back of the photo. (4cmX3cm)

Date of birth Do not fill in at the frame marked . The Graduate School of Engineering, Kyushu University

EXAMINATION CARD
Examinees number The applying program Name in Japanese Katakana and Roman block capitals

Date of birth The Graduate School of Engineering, Kyushu University Note

1. 2.

Do not fill in the frame marked . Those who don't have this vote cannot enter the examination room.

(Applicants who intend to apply in accordance with qualifications (5) (8) only)

Year

Month

Day

Application for Recognition of Academic Requirements

To Dean The Graduate School of Engineering Kyushu University

Name in Roman block capitals

Name in Japanese Katakana (If you know) Date of Birth

Year Month Day

For an individual evaluation of academic requirements as an applicant to the International Masters Program of the Graduate School of Engineering (International Masters Program in I hereby apply for all of the related documents.

Please do not fill in as follows.

Academic Requirements YES NO

Name of Chairperson

 International Masters Program in Chemical Engineering

Do not fill in at the blank marked

Examinees
number

Registration of the optional subject

Applicants for International Masters Program in Chemical Engineering have to submit

Name in full, in native language Name in Roman block capitals Name in Japanese Katakana if you know
Put the circle mark :on the three subjects in the specialized subjects.

Specialized subjects Reaction Engineering Fluid Dynamics Heat Transfer Process Control Fundamentals of Bioengineering Biochemical Engineering

 International Masters Program in Earth Resources Engineering

Do not fill in at the blank marked

Examinees
number

Registration of the optional subject

Applicants for International Masters Program in Earth Resources Engineering have to submit

Name in full, in native language Name in Roman block capitals Name in Japanese Katakana if you know
Put the circle mark :on a area in the specialized areas.

Specialized areas Economic Geology Exploration Geophysics Geothermics Resources Development and Production Engineering Rock Engineering Mineral Processing Energy Resources Engineering

International Masters Program in Hydrogen Energy Systems

Do not fill in at the blank marked

Examinees
number

Registration of the optional subject

Applicants for Hydrogen Energy Systems have to submit

Name in full, in native language Name in Roman block capitals Name in Japanese Katakana if you know
Applicants for International Masters Program in Hydrogen Energy Systems must choose Group A or Group B and put the circle mark :on these either. When you choose Group B, put the circle mark :either of Thermal Engineering or Physical Chemistry and either of Fluid Engineering or Electrochemistry too.

Specialized subjects Group A Mechanics of Materials Dynamics of Machinery Thermal Engineering Fluid Engineering Mathematics English

Group B

Mechanics of Materials Mechanics and Materials Science Thermal Engineering OR Physical Chemistry Fluid Engineering OR Electrochemistry Mathematics English

 International Masters Program in Aeronautics and Astronautics

Do not fill in at the blank marked

Examinees
number

Registration of the optional subject

Applicants for International Masters Program in Aeronautics and Astronautics have to submit

Name in full, in native language Name in Roman block capitals Name in Japanese Katakana if you know
Put the circle mark :on the two subjects in the specialized subjects

Specialized subjects
Fluid Mechanics Thermodynamics Mechanics of Materials Control Engineering Quantum Mechanics

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