Faculty of Economics, BA/MA Form 1
BA/MA Programmes (Sciences Po / Bocconi / Cologne / HEC)
Application Form 記入は日英どちらの言語でも可。You may fill out this form in
either English or Japanese.
フリガナ Name in KATAKANA
氏 名 Name in Kanji
or Roman Script
Last Name First Name
学年・組 Year, Class 3 - ＿
学籍番号 Student ID No.
現住所 Current Address
連絡先 Contact Information
Phone （ ） － Mobile phone（ ） － E-mail（1）【PC】 E-mail（2）
保証人氏名 Guarantor’s Name
保証人 住所・電話
Address and Phone No. of your Guarantor
〒 Phone（ ） －
取得済み卒業単位数 Total number of graduation credit units obtained at
the
time of application
GPA (accumulated GPA)
該当するものに
チェック
Check if applicable
□ 研究会 Research Seminar
指導教員 Advisor _____________________
□ 研究プロジェクト Independent Research Project
指導教員 Advisor ____________________
□ PCP
応募するプログラム・ 専攻
（第1・2希望を記入）
Please indicate your preferences among the four universities and
for their programmes as appropriate. If you are only interested in
one university/programme, do not indicate a second or third
preference.
✔ 1 2
□ _ _ Sciences Po
□ _ _Bocconi
□ _ _ Cologne
□ _ _ HEC (PEARL students only)
_ _ International Management and Sustainability _ _ Finance and
Strategy
_ _ Management _ _ Marketing Management _ Economics and
Management in Arts, Culture, Media and Entertainment _ _ Economics
and Social Sciences
提出論文タイトル （Bocconi / Cologne / HEC） ［Sciences Poのみに応募する
場合は不要］
Title of the research paper submitted
(Bocconi / Cologne / HEC) [Not required if you are only applying
for Sciences Po]
Category □ 三田祭論文 Mita-sai research paper □ 研究ﾌﾟﾛｼﾞｪｸﾄ
Independent Research Project □ PCP FPGE research paper □ Other
_____________________________________
経済学部独自枠派遣交換留学にも応募していますか？ Are you also applying for an exchange
programme in the Faculty of Economics? □ はいYES □ いいえ NO
写真 Photo 脱帽上半身正面，背景な
し，縦 4cm，横 3cm，最近 3 ヵ月以内に撮影したもの A photo taken within the last
three months with a plain background, size 4cm × 3cm. Look straight
ahead with your head uncovered.
記入不要 Leave blank
Application Form
