APPLICATION FORM TO GRADUATE PROGRAM

for October 2020 Enrollment

Department of Civil Engineering, Yokohama National University

Note to Applicant: This application form consists of five pages. Type or print clearly. This
form must be submitted with other necessary documents.

1.-1 Program applied: □ Doctoral program □ Master program

　　1.-2 Select one/both program(s) you prefer to apply.
If you select both, indicate your 1st preference in ( ).
　□ Civil and Development ( )
　□ Civil and ICT/IoT ( )
* This program is carried out with JICA’s program of
“Innovative Asia”. (e.g. support for internship)

2.Field of study applied: □ Civil engineering

3.Name in full in native language 　　 　　　　　　 , Arslan Amjad

　　 　　　　　　　　　　 (Surname) (Given name) (Middle name)

In Roman block capitals 　　 , 　　 ARSLAN 　　　 AMJAD

　　 　　　　　　　　　　 (Surname) (Given name) (Middle name)
* Please write your name exactly as it appears in your passport.

4.-1 Nationality: PAKISTANI 　 4.-2 Japanese nationality

Attach here a recent photograph taken within the last 6 months
　　　　　　　　　　　　　　　　　　　　　　　　　　　□ Yes, I have.
(4.5cmx3.5cm)
　　　　　　　　　　　　　　　　　　　　　　　　　　　□ No, I don’t have it.

　　　　　　　 5. Sex: □ male □female

6. Marital status: □single □married

7. Date of birth: 29-May-1997 8. Age (as of April 1, 2020): 23 years

9. Mailing address (Give address where you are surely contacted until October 2020.
If you plan to move, give present address and future address and show valid period.):

　 Present address: Punjab School of Mines Colony Katas, District Chakwal, Punjab,
Pakistan
Telephone number: +923321731778
Facsimile number (if available): -
E-mail address: arslanamjad07@gmail.com
10.Field of specialization studied in the past （ Be as detailed and specific as possible.)

11. Academic Background: 　

Year and Month Diploma or Degree
Name and Address Duration of
　　　　　 of Entrance and Awarded, Major Subject,
of School Attendance
Completion Skipped Years/Levels
Name From 4
Primary
Mission High School, 2003 years
Education
Dalwal
and Elementary education.
Elementary
To
School
Location Dalwal, District 2007 months　　
Chakwal.
Name From 3
Mission High School, 2007 years
Secondary
Dalwal
Education
and
Secondary Education
To
Middle School
2010 months　　
Location Dalwal, District
Chakwal.
Name From 3
Leader House Secondary 2010 years
School
High School
and Got Matriculation.*-1
To
LocationChoa Saiden 2013 months　　
Shah,Chakwal.
NameFazaia Inter College From 2
Tertiary
KallarKahar 2013 years
Education
Got HSSC with Mathematics,Physics and
and
Undergraduate Chemistry as majors.
To
Level
LocationKallarKahar,disst 2015 months　　
Chakwal.
Graduate NameAbdul Qadeer Khan From 4 Graduated and awarded the degree in

Level Institute of Technology, 2015 years Bachelors of Civil Engineering with

Mianwali. majors of concrete ,water

and engineering,,bridge technology, steel

To structures ,transportation engineering.

2019 months　　
Location Mianwali, Disst
 Mianwali.

Total number of
years of the
　　　　　　 16 years
aforementioned
　　　　　
schooling (as of
April 1, 2020)

Notes:
１． Exclude kindergarten education and nursery school education.
２． Preparatory education for university admission is included in secondary education.
３． If the applicant has passed the university entrance qualification examinations, indicate this in the column with “*-1.”
４． Any school years or levels skipped should be indicated in the fourth column (Diploma or Degree Awarded, Major Subject, Skipped
Years/Levels). (Example: Graduated high school in 2 years.)
５． If you attended multiple schools at the same level of education due to moving house or readmission to university, then write the
schools in the same column and include the number of years of study and current status for each school.
６ . Calculate and write the total number of years studied based on duration as a student. (including extended leave such as summer
vacation)
７ . You may use a separate piece of paper if the above space is insufficient. In such a case, please stipulate that the information is on a
separate page.

12. If you have published any papers or books (including a graduation/master thesis authored
by the applicant), state the titles or subjects of the books or papers with the name and address
of the publisher and the date of publication.

13. Employment record (Write employed period, employer’s name, job title and job
description. Start with the most recent employment.):

　　
　 period 　　　　 employer’s name 　　　　　 　　　　　 job title and description

　　

　　

14. Other professional experiences if any:

15. Present status:

16. Field of interest　 (Select one of them.)

　　
□1. Structural
　□ 2. Estuarine and Coastal
　□ 3. Geotechnical
　□ 4. Transportation and Urban Engineering
　□ 5. Concrete

17. Field of interest in detail and study plan at Yokohama National University:
*Use separate sheet and attach to this form.

18. Future plan after completion of the program:

19. Information of two referees who write a recommendation letter for you. (Two
recommendation letters in specific form should be sent directly to the Department.)

(1) 　　
name 　　　 title 　　　　 institution

(2)
name 　　　 title 　　　　 institution

20. List of other graduate schools you are applying to:

　　　

21. Will you surely be able to come to Japan in the last week of September, 2020?
□ Yes □ No (explain reason.)

22. Japanese language proficiency: Evaluate your level and insert an X where appropriate in
the following blank space.
Excellent Good Fair Poor
Reading
X
Writing
X
Speaking
X

23. Language ability: Evaluate your level and insert an X where appropriate in the following blank 　
space.
　　 Excellent Good Fair Poor

English
X
French X

German X
 Spanish X

24. Past awarded record

Have you been awarded a Japanese Government (Monbukagakusho, MEXT)
Scholarship in the past? Please check ⅰ) orⅱ) below. If so, please specify the period,
the name of the university, etc.
　　□ⅰ ) Yes, I have.
　 Period: University:
□ⅱ) No, I have not.

25. Accompanying Dependents (Provide the following information if you plan to bring any
family members to Japan.)
* All expenses incurred by the presence of dependents must be borne by the grantee.
He/She is advised to take into consideration various difficulties and the great
expense that will be involved in finding living quarters. Therefore, those who wish to
be accompanied by their families are advised to come alone first and let their
dependents come after suitable accommodation has been found.

Name Relationship Age

26. Person to be notified in applicant's home country in case of emergency

　ⅰ） Name in full: Amjad Ansar
　ⅱ） Address with telephone/facsimile number, and email address.
　　　　 Present Address ： Punjab School of Mines Colony Katas, District Chakwal, Punjab,
Pakistan

　　　　 Telephone/facsimile number ： +923331534358

　　　　 E-mail address： amjad.ansar67@gmail.com
Ⅲ ） Occupation: Government Employee.
　Ⅳ） Relationship to applicant: Father.

27. Immigration Records to Japan

Date Purpose
From

To
 From

To

28. I certify that I have read all instructions and that information in this application is true and
complete. I understand that misrepresentation may be cause for canceling my admission.
I understand that all credentials and documents I submit become the property of
Yokohama National University.

　 　　　
　　 signature of applicant 　　 date