Application for Admission as an Exchange Student · Application for Admission . as an Exchange Student -JUSST (Japanese University Studies in Science and Technology ) Program - Form

Application for Admission as an Exchange Student

- JUSST (Japanese University Studies in Science and Technology ) Program - Form A

1. Ensure that you complete all sections of this form in English unless specified before priting.Select your answer properly in multiple choices.

2. Sign your name, date and mark by hand in the designated place on the printed form.3. Submit the signed form with other supporting documents by registered express mail or using courier services.

The information completed by you in this application form will be used only for the purpose of your application assessment and our reference.

Ⅰ.Personal Information (as shown in your passport)

Postcode：

Country：

II. Correspondence Address

No.and Street Name：

Suburb / Town：State /

Prefecture：

Telephone No.：+( )Country Code

Facsimile No. +( )Country Code

E-mail Address：

Family Name(s) in English： Family Name(s) in your native language：

Middle Name(s) in English：Middle Name(s) in your native language：

First Name(s) in English： First Name(s) in your native language：

Date of Birth: (d) /(m) /(y) Sex： Marital Status：

Country of Citizenship： Second Nationality： (Only if you have double citizenship.）

Country of Birth： Prefecture/State：

City Passport Number：

Date of Issue: (d) /(m) /(y) Date of Expiry：(d) /(m) /(y)

Application period ends on May 15th for the following Fall semester (October-March). Application period ends on December 15th for the following Spring Semester (April-September).

Attach (3 cm ×4cm）

photo of yourself.

The photo must be taken

in the last one　month

before you submit this

　　　application.

©The University of Electro-Communications (UEC Tokyo), Japan A-1

III. Contact Information of your parent(s) or guardian(s)

Name of Father： Name of Mother：


Suburb / Town： Postcode：

State / Prefecture： Country：

Telephone No. ：+( )Country Code

Facsimile No.：+( )Country Code

E-mail Address：

IV. Contact Information for EmergencyName of Contact Person in your country ：

Relationship to the applicant ：


Suburb / Town： Postcode：

State / Prefecture： Country：

Telephone No. ：+( )Country Code

Facsimile No.：+( )Country Code

E-mail Address：

Ⅴ-1. Academic Background (Beyond high School)

(Commencement） (Completion）（Name of the Institute）(Name of Major Study）（Study Level） From (m) 04 /(y)1994 To (m) 03 / (y) 1998 The Univ.of

Electro-Communications Electronic Eng. B. Eng.

From (m) /(y)

From (m) /(y)

From (m) /(y)

To (m) /(y)

To (m) /(y)

To (m) /(y)

Ⅴ-2. Employment Background (including part-time jobs)

（Company & the Institute) (Position) （Work Hrs. ) (Commencement) (Completion)(i.e.)From

(m) 04 /(y) 1994 To (m) 03 /(y) 1998 The Univ.of

Electro-Communications Teaching Assistant 4 h/wk.

From (m) /(y) To (m) /(y)



h/wk.

h/wk.

h/wk.


(i.e.)

VI. Your Current Enrolment Information at your home university

Name of the University /Institution

you are currently enrolled at ：

Name of Faculty or Graduate School you are currently studying at ： (If known)

Name of your School / Department ：

Full name of academic degree(s)You are currently studying for ：

Name of your (first) major study subject at your university ：

When did you start this major study at this institute? or when did you enter your university in this study? From (d) /(m) /(y)

Your Current School Year in this major study (Select your course) (Enter your year )

(at the time when you enter UEC)

Name of your other major study or minor subject at your university(If there is any)

：

When did you start this study at this institute? or when did you enter your university in this study?

Your Current School Year in this study

(Select your course) (Enter your year)

(at the time when you enter UEC)

(A) How many semesters or terms does your university have in one year? Semesters / Terms

(B) How many minimum years your (first) major degree is required to study at your university? Years

(C) How many minimum years your other major /minor degree is /are required to study at your university?（If applicable） Years

(D) When do you expect to graduate from your university, if you do not come to Japan for your Exchange Study? (m) /(y)

(E) Do you currently have a plan to go to a graduate school of your home university for your further study after you finish your current study program?

(F) Do you currently have any interest to go to Japan for your further study after your finish your current study program?

Ye s / No

Ye s / No


From (d) /(m) /(y)

VII. Your proposed Study at the Exchange Study Program JUSST at UEC

(A) Indicate your proposed semester/s of study (mark appropriate season/s you wish to enrol). Note that you can mark one single semester or two continuous semesters only. If you wish to enrol for a full academic year, you have to choose two continuous semesters from the following three semesters available. If you wish to enrol for only one semester (a half year), then choose only one semester from the followings.

(Multiple choice)

Fall Semester Spring Semester Fall Semester (October-March) (April-September) (October-March)

(B) Class and lecture information (including subject title) in previous semesters can be found on our Homepage (http://www.fedu.uec.ac.jp/JUSST/). Please note, however, that courses actually offered in the upcoming semester may

not be finalized until a couple of weeks before the start of the semester, and they may deviate from those in previous

semesters. If you have no access to our WEB page by some reason, write an E-mail or letter to our office.

(C) About laboratory assignment JUSST program requires every student to take “Independent Research Project” for a graduate student or “Indivisual Study Project” for an undergraduate student. In these projects, every student is supposed to be assigned to one of research laboratories in UEC and receive advices from the faculty member. After your arrival at UEC, you will have opportunities to discuss with JUSST coordinators about your research/study interests, any specific research/study topics and so on so that we can arrange the laboratory assignment for you. If you already know a specific faculty member in UEC and wish to be assigned to his/her laboratory please provide the following information.

For answering the following questionnaire, use the department abbreviation below.

J InformaticsI Communication Engineering and Informatics M Mechanical Engineering and Intelligent SystemsS Engineering Science

Prospective UEC Research Supervisor Name Name of UEC Department

(First Preference) Has this professor accepted you for your research project during your prospective exchange study? (If you answer “Yes”, attach the proof of your communication with this professor, i.e.E-mail or letter.)

(Second Preference) Has this professor accepted you for your research

project during your prospective exchange study? Yes/No

(Third Preference) Has this professor accepted you for your research project during your prospective exchange study? Yes/No

(D) What is the title and field of your research proposal which you wish to research under UEC Supervisor mentioned-above?

A-4

©The University of Electro-Communications (UEC Tokyo), Japan

Yes/No

MS Human Media Systems SS Social Intelligence and Informatics NS Information Network SystemsFS Information System Fundamentals

http://www.fedu.uec.ac.jp/JUSST/)

http://www.fedu.uec.ac.jp/JUSST/)

VIII. English Proficiency (Skip this section if you are applying from Australia, Canada, UK or USA)

Most classes and lectures in this JUSST Exchange Program are run in English. It is therefore

important that the students have enough English skills to follow the studies.

(A) Are you confident in instant communication in English conversation? Y es /N o

(B) Are you confident in writing a scientific report in English?

(C) Is English your first language ? Ye s / N o

(D) Have you taken one of the following international English tests?

Fill in your record appropriately. You also have to attach the proof of the record for the test that you took before.

Name of English Test Have you taken before? Last Exam’s Date you took Score Note

TOEFL Yes/No (d) /(m) /(y)

TOEIC Yes/No (d) /(m) /(y)

IELTS Yes/No (d) /(m) /(y)Overall Score Band

CET Yes/No (d) /(m) /(y)

Your Home University English Test

Name of Exam (d) /(m) /(y)

Your Nation-wide English Test


Other International English Language Test


(E) Do you intend to take any one of those international English tests near future?

No /Yes ⇒ If Yes, which exam are you applying for? Exam Name:

Which date are you sitting in the exam? Exam Date: (d) /(m) /(y)

(F) If your answer No for all questions from (C) and (E) above, do you have any other official document which shows your fluency in English? i.e. academic record at your university or high school

No /Yes ⇒ If Yes, write the name of documentName of Document：(Attach the original document or certified copy of the document)

IX. Japanese ProficiencyWhen you participate in this JUSST Program, you have to take Japanese Language Classes as core subjects at UEC. However, you are not required of Japanese language fluency at all. Information about your study record of Japanese language will help us to organize appropriate Japanese Language Classes when you come to UEC. Please answer to the following questions.

Ye s/ N o


Note that you can be exempted from taking these Japanese Language classes in your second semester, if you are a graduate student and if your UEC research supervisor allows you to be exempted from taking these classes.

(A) How are you going to enrol in Japanese Language Classes?

Only First Semester / Both Two Semesters / Have not decided yet

(B) Indicate your study record of Japanese Language if there is any.

Study Duration Name of Institution

Name of Instructor

Class Hours (Hrs./week)

How many weeks

Textbook used in the training

From (m) /(y) To (m) /(y) Hrs./week Wks.



(C) Have you been in Japan?

No /Yes ⇒ If Yes, How many times? days in total time(s) How many days in total?

/(m) /(y) to (d) / (m) / (y) The latest entry: from (d)

⇒ If Yes, answer the appropriate below.

No /Yes

No /Yes

⇒ If Yes, about Japanese Kanji Characters

(Do not count Chinese Kanji Characters, although they are similar or the same sometimes.)

Study Duration Name of Institution

City Name of Institute Location

Was it for an Exchange

Study

Did you have any scholarships?

From(m) /(y) To (m) /(y)Y/N Y/N

Name of Scholarships?

From (m) /(y) To (m) /(y)Y/N Y/N

Name of Scholarships?

From (m) /(y) To (m) /(y) Y/N Y/N Name of

Scholarships?

©The University of Electro-Communications (UEC Tokyo), Japan

X. Financial Source and Support For those applicants who have passed our entrance screening, UEC will apply for the scholarship at the Japan Student Support Organization (JASSO) under the Japanese government (Ministry of Education, Culture, Sports, Science and Technology) scholarship scheme. UEC may supplement the number of scholarship recipients by providing its own UEC scholarship. Note, however, that the stipend may not be sufficient for an average UEC student to live in Tokyo. Also please understand that the number of JASSO/UEC scholarship is limited and therefore we may not be able to provide the scholarship to all applicants even though they have passed our entrance screening.

A-6

(D) Have you ever studied in Japan before? No/Yes

(E) Can you fluently read and write Hiragana?

(F) Can you fluently read and write Katakana?

(G) Can you read and write Kanji? No /Yes

(A) If JASSO/UEC scholarship is not available do you still wish to apply for admission to this UEC Exchange Program JUSST ? Yes/No

If your answer is No (that is, you are interested in JASSO/UEC scholarship only),

skip the following items (B),(C),and (D). If your answer is Yes, answer the following item (B).

(B) What will be your main financial source while you study in the UEC Exchange Program?

Funds from other Sponsor (such as your university’s scholarship) see the item (C)Your own fund (such as savings of your own or parents) see the item(D)

(C) If your answer is "Funds from Other Sponsor" to the above, the statement of financial support from the sponsor is required (attach it).

1. Official Name of Your Scholarship:

2. Amount of the Scholarship: in total / per month

3. Period you receive the Scholarship: months

(D) If your answer to the above (B) is Your own fund, the detailed financial statement which proves that the

- Passed our entrance screening

- Accommodation is available (JASSO/UEC scholarship recipients have priority)

- Firm commitment of fund provider

Note that there is no guarantee for your application to be successful although you have your own funds for your study in

Japan. The quota of successful applicants in this program will be decided depending on the availability of

accommodation every year.

XI. Total Period of Education (from elementary school to the last institution of education)（Sort of Education Inst.）

（i.e.） Elementary School

From (m) 04 /(y) 1986

To (m) 03 /(y) 1992 (Years attended)





years

years

years

years

years

XII. Confirmation of Your Document Preparation

(Mark by hand)

jusst_form_A.pdf □① Form A (this form): Application for Admission as an Exchange Student

uec_form_H.pdf


When you complete this form, you should send this application form to the International Affairs Office at your university, attaching following documents. Confirm all of them and then mark each square below for your confirmation before submission. If there is any missing document, your application may not be processed. Failure to complete this section will result in an “Invalid Application”.

(Commencement) (Completion)

6

□②　1 photo of yourself (3 cm ×4 cm ) attached to Form A

□③ 3 photos of yourself (3 cm ×4 cm )

□④ Form H ：Certificate of Health for Overseas Applicant to UEC

amount of fund is enough to support your study in Japan for the period of JUSST program, as well as its availability status is required for the issuance of student visa in Japan. Submission of this document, however, is necessary only when you met all the conditions as indicated in the following.

□⑤ JASSO Scholarship Application: Certificate of Enrollment of the Applicant for Student Exchange Support Program jasso_form.pdf

□⑥ Proof of English proficiency: e.g. a copy of official score report of TOEFL, TOEIC, IELTS or other tests (only if your first language is not English)

□⑦ Transcript of current academic record for your degree(s) currently enrolled

(Original only, no older than 1 month old)

□⑧ Transcript of academic record for your degree(s) which you were already awarded (Original only)

□⑩ Form RP: Prospective Research Proposal if you are a graduate student

uec_form_RP.pdf uec_form_RP.docx

□⑪ Form R: Referee's Report for Exchange Student at UEC uec_form_R.pdf uec_form_R.docx

□⑫ Certified copy of your passport

□⑬ Certified copy of your student ID

□⑭ Video Letter #1 of 3 minutes with topic on your study/research background and current study activities at your home university

□⑮ Video Letter #2 of 3 minutes with topic on your motivation to apply our JUSST Program and on your future prospects and carrier relating your prospective experience in our JUSST Program at UEC

□⑯ Any other supporting document(s) if necessary

XIII. Declaration of Applicant

I, (Write your name by hand)

, declare that information provided by me in this application is solemnly

true and correct to my best knowledge. I authorize any other person or organization to supply information to the University of Electro-Communications regarding this application. I understand that the University of Electro-Communications reserves all the rights to revoke any decision for all matters relating this application.

Signature of Applicant: Date of signature (d) /(m) /(y)

Applicants are reminded of the Application Calendar of UEC Exchange Program

Fall Semester Entry Process:

15th May Deadline for application for October entry in Fall semester

Early July Notification of acceptance is sent by E-mail.

August-September Certificate of (Visa) Eligibility is delivered. Preparation for student Visa at Japanese missions in your country

First Day of October Arrival at UEC Tokyo, Japan

First Week of October Orientation and Fall semester start


□⑨ Form SP: Study Plan when you come to UEC, associating with your current studies/research at your home university (at least 2 pages) uec_form_SP.pdf uec_form_SP.docx

Spring Semester Entry Process:

15th December Deadline for application for April entry in Spring semester

February Notification of acceptance is sent by E-mail.

Late February-March Certificate of (Visa) Eligibility is delivered. Preparation for your Student Visa at Japanese missions in your country

First Day of April Arrival at UEC Tokyo, Japan

First Week of April Orientation and Spring semester start

Sender’s University Office Use Only

(A) Please indicate the G.P.A. (Grade Point Average) G.P.A. for Undergraduate = of this applicant at your university.

G.P.A. for Graduate =

(B) How many applicants do you have next semester?

(C) How do you rank this applicant of them (B)? Please indicate the number. of number of (B)

(D) Please write your supplemental note if there is:

(E) Recommendation by International Affairs Office or Faculty Office at Home University

Title: Name:

Position:

Contact Postal Address:

City State Country

Telephone No.：+( )Country Code

Facsimile No. +( )Country Code

E-mail Address： Homepage:

Signature of Recommendation Date: (d) /(m) /(y)


Documents

Application for Admission as an Exchange Student · Application for Admission . as an Exchange Student -JUSST (Japanese University Studies in Science and Technology ) Program - Form