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Academic Year 2020 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number
Form A Application Form * Do not fill out this section.
The program applying for
The name of the course
applying for
Examination Category
Program Course Domain Examination date Examination Types
Master’s Program
Doctoral Program
Environmental and
Information Studies
(Yokohama Campus)
Urban Life Studies
(Todoroki Campus)Domain
Schedule B
[September]
Schedule C [February]
General Screening
Screening for working adults
Special Screening for international students
Validation stamp of
consent to application by
research supervisor
*1
Seal*1: Required. From the Domains and Instructors on page 6, applicants are required to
obtain a signature and validation stamp from the instructor (not marked with an
asterisk *) of the course or domain applying for.
*2: If the instructors are marked with a triangle or a diamond (those who will teach until
the middle of each program year) in the Domains and Instructors on page 6,
applicants are required to obtain a signature and a validation stamp from the
instructor who will subsequently take over up to the final year.
*3: The staff marked with an asterisk (*) in the Domains and instructors on page 6 are
assistant research supervisors. Applicants cannot apply only by obtaining an
approval from “*: Assistant research supervisors.” Applicants are required to
obtain a signature and a validation stamp from “research supervisors not
market with an asterisk (*)” within the same domain.
*4: Only for the Doctoral Program: For the Doctoral Program, applicants are required
to determine an advisor. (For details, refer to page 14)
Validation stamp of
consent to application by
the instructor who will
subsequently take over
*2
Seal
Validation stamp of
consent to application by
assistant research
supervisor
*3
Seal
Validation stamp of
consent to application by
advisor
*4
Seal
Full
Name
Katakana
Kanji
Family Name Given Name
*Please fill out using katakana or alphabets if you cannot fill out using kanji characters.
Current affiliated laboratory
* To be filled out by applicants advancing internally.Student Number
Registered
Domicile
Fill out the name of prefecture
(nationality for international students)
Gender□ Male
□ FemaleDate of Birth Born in Month Day , Year
(Age )
Fill out the age as of April 2, 2020.
Academic
background,
etc.
High schoolYear , Month
Graduated from
□ Graduated
UniversityYear , Month
University Faculty of Department of
□ Graduated
□ Expected to graduate
Graduate school Year , Month
Graduate School:
Doctoral Program (first semester) [Master's Program]:
□ Completed
□ Expected to complete
Work experience
If any, fill out the name of company, year and month of joining, the number of years in service,
etc.
Applicant
Address
Start from the name of prefecture. Please correctly fill out the name of apartment/condo.
Zip code -
Tel (Cell phone) ( ) - E-mail address @
Academic Year 2020 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number
Form B Secondary Form (Photograph Ticket)* Do not fill out this section.
Full NameKatakana <Affix a photograph here>
1. The photograph must be taken for
identification documents (color
photo is also accepted).
2. The photograph must be taken
within three months. It must be
taken from the waist up, directly
facing the camera, and bareheaded.
3. The photograph must be four cm in
height and three cm in width without
frames.
4. Spread glue all over the surface.
5. Write down the applicant’s name
and the name of the course
applying for on the back of the
photograph.
The name of the
course applying for
Environmental and Information Studies (Yokohama Campus)
Urban Life Studies (Todoroki Campus)
The name of the
domain applying forDomain
(Affix receipts in the blank space below.)
Academic Year 2020 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number
Form C Statement of Purpose and Research Plan* Do not fill out this section.
Program Course Domain Full Name
Master’s Program
Doctoral Program
Environmental and Information Studies
(Yokohama Campus)
Urban Life Studies
(Todoroki Campus) Domain
<Read below before filling out>
Write down the reasons for applying for the graduate school and research plan using 1,500 to 2,000 characters (including figures) in total.
Be sure to contact and consult with the instructor of the domain applying for in advance prior to writing.
Use a word processor or Microsoft PowerPoint when writing.
Submit a copy after pasting if you cut and paste.
<Affix a photograph here>
1. The photograph must be taken for
identification documents (color
photo is also accepted).
2. The photograph must be taken
within three months. It must be
taken from the waist up, directly
facing the camera, and bareheaded.
3. The photograph must be four cm in
height and three cm in width without
frames.
4. Spread glue all over the surface.
5. Write down the applicant’s name
and the name of the course
applying for on the back of the
photograph.
Intended for the applicants of the [Screening for working adults]
Academic Year 2020 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number
Form D Curriculum Vitae * Do not fill out this section.
Program Course Domain Full Name
Master’s Program
Doctoral Program
Environmental and Information Studies
(Yokohama Campus)
Urban Life Studies
(Todoroki Campus) Domain
Do you want to apply for tuition reduction and exemption?
□ Yes, □ No (Check either of the boxes.)
Era Year MonthAcademic Background
Fill out the final school enrolled and graduated (completed).
Era Year MonthProfessional Experience
Besides work experience, fill out research achievements in detail.
Please provide the publication of any research that falls under the categories provided in the margin.
Title Corresponding number for
the institution published to [Corresponding number
for the institution published to]
1. Paper (academic journal, association
journal)
2. Verbal presentation at academic
conference
3. In-house newsletter
4. In-house research group
5. Patent filings
6. Awards, etc.
Intended for the applicants of the [Screening for working adults]
/Doctoral Program: Intended for the applicants applying under the eligibility categories (6) or (7)
Academic Year 2020 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number
Form E Letter of Recommendation * Do not fill out this section.
Date:
To the President of Tokyo City University
Recommended by Seal
Affiliation
Job title
Relation with the applicant
I would like to recommend the following person as an applicant who wishes to study at the Graduate School of Environmental and Information Studies, Tokyo City University.
Applicant Name
(Date of birth) Date of birth:
The program applying for
The name of the course applying for
Master’s Program
Doctoral Program
Environmental and Information Studies (Yokohama Campus)
Urban Life Studies (Todoroki Campus)Domain
Do you want to apply for tuition reduction and exemption?
□ Yes, □ No (Check either of the boxes.)
1. Please fill out the reason for recommending the applicant, including the applicant’s major work experience and research area.
2. Please provide the publication of any research that falls under the categories provided in the margin.
TitleCorresponding number for the
institution published to [Corresponding number
for the institution published to]
1. Paper (academic journal, association
journal)
2. Verbal presentation at academic
Intended for the applicants of Doctoral Program
Academic Year 2020 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number
Form F The Summary of Research in the Doctoral
Program (First Semester), Etc.
* Do not fill out this section.
Program Course Domain Full Name
Doctoral ProgramEnvironmental and Information Studies
(Yokohama Campus) Domain
The Summary of Research in the Doctoral Program (first semester) [Master’s Program], Etc.
Research title and
the title of the paper
Summary of the content
Books
Book Name Published by Year and date of publication
Academ
ic Papers
Paper NameName of magazine
presented toYear and date of presentation
Pu Title Institution presented to Year and date of presentation
Intended for the applicants of the [Special Screening for international students]
Academic Year 2020 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number
Form G Special Screening Application Form* Do not fill out this section.
Program Course Domain Full Name
Master’s Program
Doctoral Program
Environmental and Information Studies
(Yokohama Campus) Domain
The flow of application procedure
(1) In principle, the applicant must use this form to request the Instructor for the
program that the applicant is applying for more than a month prior to the
submission of the application.
(2) The course will determine application eligibility for a special screening.
(3) If it is determined that the applicant is eligible to apply, the seal for the approval by
the course will be affixed at the bottom of this form. The instructor of the course for
which the applicant is applying will return the form to the applicant. (If not approved,
the applicant will be treated as general admission.)
(4) At the time of the submission of application, please send this form along with other
application forms.
Eligibility
Applicants who are eligible for general screening and acquire sufficient
accomplishments in the area related to the course.
* The eligibility of applicants will be determined after the advanced submission of
application by applicants upon screening by the relevant course.
*Students who are expected to graduate from TCU and graduates of TCU are
ineligible. In principle, this special screening is intended for international
students.
Screening method
Candidates are selected based on the overall performance of the
screening of the application documents and interview, including an oral
examination. However, depending on the status of enrollment, the school
may instruct candidates to provide a presentation of the research plan or
take an examination for specific subjects.
■ To be filled out by the applicant
Application schedule
□ Schedule B [September]
□ Schedule C [February]* Please check the box for the application schedule.
Special Screening
Reason for
application eligibility
(Summary)
Please fill out the summary of reasons for the application in this section and fill out the details on the reverse side. If there are any related materials, please attach
separately.
Fill out the details on the reverse side.
■ To be filled out by the courseAs a result of the determination for the course for the applicant above, the special screening will apply to the applicant for the entrance examination for the Graduate
School of Environmental and Information Studies for Academic Year 2020.
Date:
Graduate School of Environmental and Information Studies,
Tokyo City University
Dean of the Graduate School
of Environmental and Information Studies,
Tokyo City University Seal
Examination content
Program Course Domain Full Name
Master’s Program
Doctoral Program
Environmental and Information Studies
(Yokohama Campus) Domain
■ To be filled out by the applicant
Reason for application eligibility for special screening (Details)
Academic Year 2020 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number
Form H Applicant Survey Form[For International Students]
* Do not fill out this section.
[Please note that this survey form must be carefully answered and filled out entirely by the applicant in his/her own hand]
■Information about the applicantThe program/course
applying for
Graduate School of Environmental and Information Studies, Master’s Program/Doctoral Program
Course: Domain
(Katakana) Last Name ( ) First Name ( )
Full name in kanji
Full name in Roman
characters
Date of birth Month Date , Year (dominical year) Gender Male / Female
Country or region of
origin
Current resident status□Study abroad □Other ( ) [Residential visa expiration: Month Date , Year (dominical year)
□Currently, I do not have any resident status because I reside outside Japan.
Date of landing
permissionMonth Date , Year (dominical year) [Port of arrival: ]
Record of stay in Japan
*Please tell us about your stay in
Japan in the past three months or
more.
*If the applicant resides outside of Japan, it is not necessary to fill out the sections for resident status and the landing permission.
However, if the applicant has lived in Japan for more than three months in the past, please provide the reason and the name of institution in the section for the record of stay in Japan.
■Family informationPlease provide information about parents, brothers and sisters, and grandparents except for yourself. If there is not enough space, please fill out the same information
on a separate sheet and attach it.
Full nameRelationship with
the applicantOccupation Place of residence
Father
Mother
■ History of learning JapaneseBe sure to fill out if the applicant is enrolled in a Japanese-language school.
Name of institutionLocation
(country, state/province, city)Duration
Number of class
hours per weekLevel
From Month , Year to Month , Year Hours per /weekBeginner, Intermediate,
Advanced
From Month , Year to Month , Year Hours per /weekBeginner, Intermediate,
Advanced
From Month , Year to Month , Year Hours per /week Beginner, Intermediate,
Advanced
■ History of learning English
Name of institutionLocation
(country, state/province, city)Duration
Number of class
hours per weekLevel
From Month , Year to Month , Year Hours per /weekBeginner, Intermediate,
Advanced
From Month , Year to Month , Year Hours per /weekBeginner, Intermediate,
Advanced
From Month , Year to Month , Year Hours per /weekBeginner, Intermediate,
Advanced
Continue to the back page.
■ Academic background and work experiencePlease start from the applicant’s elementary school, junior high school, and high school to university in chronological order.
School name,
company name, etc.
Location
(country, state/province, city)Enrollment status and duration
Graduation, completion, transfer,
expected to graduate/complete
Joined/Withdrawn
Number of years in
school/employment
From Month , Year to Month , Year years
From Month , Year to Month , Year years
From Month , Year to Month , Year years
From Month , Year to Month , Year years
From Month , Year to Month , Year years
From Month , Year to Month , Year years
From Month , Year to Month , Year years
From Month , Year to Month , Year years
Total years in school years
Total years in employment years
■ Plans for the payment of study abroad expenses
Living expenses
Monthly average JPY
Paid by and the amount
Applicant JPY , Father/Mother JPY
Other (Full name: Relationship: ) JPY
School expenses
Amount for half year JPY
Paid by and the amount
Applicant JPY Father / Mother JPY
Other (Full name: Relationship: ) JPY
Please explain how study abroad expense will be paid. *Details on money transfer, part-time job, etc.
*Please fill out details about the person who will pay for study abroad expenses in the section below if a person other than the application is paying for both or either of the expenses.
■ Person who will pay for study abroad expensesKatakana
Age
Years old
Relationship with
the applicantFull name
Current address
Tel
Fax
Occupation
(Name of employer)
Work address
Tel
Fax
[General Screening/Screening for Working Adults] Intended for applicants who are applying under the eligibility categories (7) or (8) for the Master’s Program,
applicants applying under the eligibility categories (6) or (7) for the Doctoral Program, and applicants applying under the Special Screening for International Students.
Academic Year 2020 Graduate School of Environmental and Information Studies, Tokyo City University
Form I Application Form for the Screening of the Qualification for Enrollment
Date of submission: Month Date , Year
Program applying for
(Please circle the one)Master’s Program / Doctoral Program
Entrance examination type
(Please circle the one)General entrance examination / Screening for working adults / Special screening for international students
Katakana
Full name Male / Female
Date of birth Month Date , Year (dominical year) (Age )
Admission month
and yearAdmitted in Month , Year
Course applying for Course
Desired Instructor Instructor :
School graduated from
(Last school attended)
University / School, Department of
Graduated/Completed in Month , Year (dominical year)
Current employer
Current address
Zip code
Shipping address
Zip code
□ Same as the above (Please check the box if it is the same as the current address)
Contact
information
Home ( ) -
Mobile ( ) -
Academic Year 2020 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number
Form J Address stickers for an examination
ticket
* Do not fill out this section.
Shown below are the address stickers to mail the examination ticket after application procedure and the acceptance letter after examination.
Please fill out the address where the examinee receives the mail safely. The name must match the name of the examinee.
In addition, individual messages or assignments might be mailed before taking the examination.
□□□ -□□□□ □□□ -□□□□ □□□ -□□□□
Examinee’s name
To
Examinee’s name
To
Examinee’s name
ToAcademic Year 2020
Graduate School of Environmental and Information Studies,
Tokyo City University
Academic Year 2020
Graduate School of Environmental and Information Studies,
Tokyo City University
Academic Year 2020
Graduate School of Environmental and Information Studies,
Tokyo City University
Master’s Program
Doctoral Program
Environmental and Information Studies
Urban Life Studies
Master’s Program
Doctoral Program
Environmental and Information Studies
Urban Life Studies
Master’s Program
Doctoral Program
Environmental and Information Studies
Urban Life Studies
Domain : Domain : Domain :
* Do not fill out this section.
Identification
Number
* Do not fill out this section.
Identification
Number
* Do not fill out this section.
Identification
Number