Short-Term Exchange Programs at the University of Tsukuba, 2016-2017

Application Package Cover Sheet and Checklist

Date (Month/Day/Year) 日付

Applicant’s Name (The name written in your passport) 出願者氏名(パスポートの名前)

Chinese Characters(漢字):

Home University, Country

出身大学、国名

IMPORTANT: Your application should be sent as a package containing the items below. After including all required documents, your application package should be submitted to the International Office or the Exchange Advisor at your home university. 以下の出願書類をすべて確認し、自分の大学の国際交流オフィスあるいは学生交流アドバイザーに提出して下さい。

TO EXCHANGE ADVISOR: Please carefully check whether all items are included before sending them to us by post. ※Documents to be submitted must be accompanied with Japanese or English translations if they are written in other languages.

Documents to be submitted Check

Application Form for Enrollment as Exchange (Research) Student at the University of

Tsukuba (Form 2) 筑波大学短期留学生入学願書（別紙様式２） ☐

Formal letter of request for admission by President or Dean from the applicant’s home

university addressed to the President of the University of Tsukuba (Please use Sample A

or B) 本学学長宛の受入れ依頼書（Sample A もしくは Bを使うこと） ☐

Official transcript of academic records (Transcript must be accompanied with Japanese or

English translations if it is written in other languages.) 成績証明書 (和訳か英訳をつける) ☐

Application for Certificate of Eligibility (hard copy) and its Excel file (soft copy to be sent

from the applicant’s personal e-mail account to BOTH isc-short-term@un.tsukuba.ac.jp and the sender of this e-mail.）在留資格認定証明書交付申請書とその Excelファイルを

出願者のメールアドレスからこのメールの送信者および isc-short-term@un.tsukuba.ac.jp

に送ること）

☐

A copy of your passport, if you already have it.

(Copies should include ID page and pages with Japanese immigration stamps, if any.)

パスポートの身分証明のページのコピー （既に持っている場合）

（日本への入国歴がある場合にはそのスタンプがある頁のコピーも送ること）

☐

Three ID photos of different sizes. (Two photos sized 40 mm x 30 mm, and one of 30

mm x 24 mm) The photographs must be formal, hatless, without background, and taken

within the past three months. We will ask you to send them again if they are

inappropriate. Snapshots are not accepted.

写真3枚（4 cm x 3 cm 2枚、3 cm x 2.4 cm 1枚）証明写真として不適切な写真の場合

は、もう一度送って頂きます。スナップ写真は不可。

☐

Form 2（別紙様式２）

筑 波 大 学 短 期 留 学 生 入 学 願 書 Application Form for Enrollment as Exchange Student/Exchange Research Student at the

University of Tsukuba

I herewith submit my application for admission to the University of Tsukuba as an Exchange (Research) Student.

私は，短期留学生（特別聴講学生又は特別研究学生）として貴学に入学を希望しますので，出願書類等を提出い

たします。

Handwriting is not accepted.

Applicant’s Name written

in your passport（in English

alphabet）

出願者氏名（英語表記）

姓 Family Name 名 Given Name Middle Name

Photo

（写真）

3cm × 4cm Country of Citizenship

国 籍

Sex □ Male （男）

（性別） □ Female（女）

Date of Birth

生年月日 19 , ,

Yr. 年 Mon. 月 Day 日

Marital Status □ Single

未既婚の別 □ Married

Applicant’s Current

Address

出願者の現住所

Phone: E-mail:

Address to which

admission documents are

to be sent

選考結果の送付先

Name:

Address:

Postal code: Country:

Posta Phone: E-mail:

Name and Address of

Exchange Advisor in your

home university

交換留学アドヴァイザ

ーの氏名及び連絡先

Mr., Ms., Dr. Name:

Address:

Phone: E-mail:

Name of Home

University (in English)

在籍大学名 (英語表記)

Name:

Address:

Name of Faculty / School

在籍学部 / 学科

Department / Major

学科／専攻

Date of Admission

to Home University

在籍大学入学年月

20 /

Yr. / Mon.

Current status 在籍年次

Undergraduate (□1st □2nd □3rd □4th year)

□ Master Course (□1st □2nd □Other year)

□ Doctoral Course (□1st □2nd □3rd □Other year)

※ When you fill out this Application Form, please kindly refer to Application Guide.

Language Proficiency 語学能力

Japanese Language

Learning Background

日本語の学習歴

Name of Institution

Attended

学習機関の名称

(1) (2)

Duration of Study

学習期間

Total:

Yr. 年 Mon.

月

Total:

Yr. 年 Mon.

月 Japanese Language

Proficiency 日本語能力

(Evaluate your level and fill

in an X where appropriate.)

Excellent Good Fair Poor

Reading

Writing

Speaking

English Language

Proficiency 英語能力 (Evaluate your level and fill

in an X where appropriate.)

Excellent Good Fair Poor

Reading

Writing

Speaking

Ⅰ．Your Study or Research Plan at the University of Tsukuba 筑波大学での学修計画 (1) Proposed study or research period at Tsukuba. Please indicate below the starting and ending

date of your stay and the expected date of your graduation or completion at your home

university. 希望する学修期間と在籍大学の卒業又は修了予定年月日を記入してください。また総月数を下に記入してください。

Starting date of your study at Tsukuba *Ending date

留学開始日 留学終了日

2016 , 10 , 1 2017, 8, 31 , ,

Yr. 年 Mon. 月 Day 日 □2017, 9, 30 Yr. 年 Mon. 月 Day 日

, ,

Yr. 年 Mon. 月 Day 日 Total number of months at the University of Tsukuba: Total 11 months 総月数

*Please note that Summer recess starts 11 August, 2016.

IMPORTANT: The above dates must be identical to those indicated in the formal letter requesting admission, which was addressed to the President of the University of Tsukuba (see Sample A or B). The following table shows the academic calendar for your reference.

注：上の期日は、筑波大学学長宛の受入れ依頼書（様式Sample A or B）に記載される期間と同じものでなければなりません。

Spring Semester 春学期 April 1 to September 30 4月1日～9月30日

Fall Semester 秋学期 October 1 to March 31 10月1日～3月31日

(2) Describe your field of study at your home university 出身大学での専攻分野

(3) College or program you would like to join at Tsukuba 筑波大学で希望する学類もしくは専攻

（＊Please note that your preferred college or program may not be available. 希望するところに入れるとは限

りません。）

Expected date of your graduation or

completion at your home university 卒業（修了）予定日

(4) Courses you plan to enroll in at Tsukuba or your research topc 希望聴講科目あるいは研究テーマ

(5) Explain in detail your study plan or research plan at Tsukuba. (You can use an extra sheet of

paper, if necessary. 筑波大学での詳細な学習･研究計画 (ｽﾍﾟｰｽが足りない場合には、別紙に記入して下さい。)

Ⅱ. Financial Information (在学中の経費について)

(1) Are you applying for the JASSO Scholarship? (JASSO 奨学金に申請しますか？)

Yes はい □ No いいえ

(2) If your answered “yes” to Question 1, please also answer questions (2) and (3). Check the qualifications below. (あなたは下記の JASSO候補者の資格要件を満たしていますか？)

□ You are accepted by a Japanese university under a student exchange agreement with your home

university, and your length of stay exceeds a semester, but ends within one (1) year.

□ You do not have Japanese nationality.

□ Your country has established diplomatic relations with Japan. However, if you have Taiwanese or

Palestinian nationality, you are qualified to apply.

□ You demonstrate excellent academic record during the previous year with a GPA of 2.30 or higher on

the JASSO grade scheme. In cases where it is not possible to calculate your GPA using the above JASSO

scheme, your home university must submit an officially authorized document demonstrating that you

are a high-achieving student and your academic performance is equivalent to a GPA of 2.30 or higher.

□ You are a student with financial difficulties to study or research in the University of Tsukuba at your

own expense.

□ You are certain to obtain a “College Student” visa to study in Japan.

□ You will resume your studies or research at your home university after completing your exchange period

in Japan.

□ You will not receive any other scholarship(s) whose monthly stipend(s) exceed(s) 80,000 yen while

studying in Japan.

(3) What is your GPA? You must have a minimum GPA of 2.30 or higher to be eligible for the JASSO scholarship.

Your GPA must be calculated using the JASSO system. For calculating your GPA, please refer to the following.

Examples of grading scales used by universities

Grades

Example 1: 4-point scale - Excellent Good Fair Poor

Example 2: 4-point scale - A B C F

Example 3: 4-point scale - 100-80 79-70 69-60 59 or below

Example 4: 5-point scale 100-90 89-80 79-70 69-60 59 or below

Example 5: 5-point scale S A B C F

Example 6: 5-point scale A B C D F

Grade Points on JASSO scale 3 3 2 1 0

Converting formula:

*Your grades during the previous year must be included in this calculation. If you don’t have grade

during the previous year, you may calculate your GPA point with grade in last academic term.

Please use the following table and formula. Course Title Grade Credit JASSO Grade

Point

Total Point

Total

Converting Formula:

=

( ×3) + ( ×2) + ( ×1)+ ( ×0)

𝑇𝑜𝑡𝑎𝑙 𝐶𝑟𝑒𝑑𝑖𝑡𝑠 =

Your GPA:

Ⅲ. Student Status at Tsukuba (Only for graduate students) 学生身分(大学院生のみ) This portion is only for applicants at the graduate level, who must read and answer the below carefully.

大学院レベルの学生は、以下をよく読み記入してください。

There are two student status types for graduate students from our overseas partners: Exchange Student

and Exchange Research Student. Exchange students are required to register more than 8 periods per week.

Exchange research students will receive guidance and advice for their research from Tsukuba’s faculty

members, but they cannot earn credits. You must choose your status, either one or the other.

＊Graduate students can attend the Japanese Language Courses offered by Center for Education of global

Communication (CEGLOC), but cannot get the credits for them.

大学院レベルの特別聴講学生は週に8時限以上の科目を履修登録しなくてはなりません。特別研究学生

は、本学で研究指導を受けることを目的としており、単位を取得することはできません。

＊大学院レベルの学生はグローバルコミュニケーション教育センターの日本語の授業に参加できます

が、単位を取得することはできません。

Please indicate below the student status you choose. 筑波大学において、自分が希望する身分を選択してください。

Exchange Student (tokubetsu chokogakusei) 特別聴講学生

□ Exchange Research Student (tokubetsu kenkyugakusei) 特別研究学生

NOTE: Since you cannot change your student status after you are admitted, you must choose your status

carefully. Also, the student status you have chosen must be indicated in the formal letter of admission request

from your institution addressed to the President of the University of Tsukuba (see Sample A or B of this

guide.)

入学後の身分変更はできませんので、慎重に自分の身分を選択してください。選択した身分は、本学学

長宛の受入れ依頼書に記載されている身分と同じものでなければなりません(本ガイドのSample Aある

いはBを参考)。

Applicant’s Signature: Date: 出願者署名 日付 Month / Day / Year

Home University Endorsement (To be completed by the applicant’s exchange advisor) 出身大学における確認（以下は、出願者の学生交流アドバイザーによって確認され、署名されなければなりません。）

I have verified that the applicant is submitting a complete package containing the items listed on the Application Package Cover Sheet and Checklist. After having reviewed them, I recommend the applicant’s participation in the exchange program. 私は、出願者がチェックリストに記されている必要書類のすべてを提出していることを確認しました。それを検討した後、私はこの出願者が当該の学生交流プログラムに参加することを推薦します。

Printed Name: Job Title: _______ 氏名 職名

Signature: Date: 署名 日付 Month / Day / Year

- 17 -

The following is a sample letter requesting admission for exchange students (tokubetsu chokogakusei). Please make sure

to include the seven (7) conditions indicated below in the letter.

Date: Month Date, Year

(Example: April 1, year)

Dr. Kyosuke Nagata

President

University of Tsukuba

Tsukuba, Ibaraki, 305-8577 Japan

Dear Dr. Kyosuke Nagata:

It is my pleasure to recommend to you our undergraduate/graduate student, Mr. Michael Smith, a third-year student in the

Department of XXXXX, Faculty of XXXXX, University of XXXXX. (school year, department, faculty, university).

He is an excellent student who is very interested in the Japanese language, society, and culture. In pursuing his research theme, we

believe that he would greatly benefit from a short-term exchange program in Japan.

He would like to study as an exchange student at your university from April 201X.

We understand that the following conditions apply for his acceptance as an exchange student at your university:

His student status at the University of Tsukuba shall be exchange student (tokubetsu chokogakusei);

His period of study at the University of Tsukuba shall be from October 1, 2016 to August 31, 2017;

His field of study at the University of Tsukuba shall be [FIELD OF STUDY];

The course work done by the above student at the University of Tsukuba shall be evaluated using the University of Tsukuba

grading system;

A certificate concerning the above student's grades at the University of Tsukuba shall be issued after the completion of his

studies;

Credits received from the University of Tsukuba are fully applicable to the graduation requirements at the University of

XXXXXX; and

The above student shall be allowed to use all facilities necessary for his study at the University of Tsukuba.

I would greatly appreciate it if you would consider admitting him to your university under the conditions listed above.

Sincerely,

(Title, Name)

(signature)

XXXXX XXXXX

President or Dean at the applicant’s home university

University of XXXXXX

Sample A: For Exchange Students

Student’s name

Student’s school year,

department, faculty, and

university

Recommendation

Beginning period of

study

Please write the title and full name.

別記第六号の三様式（第六条の二関係）申請人等作成用 １ 日本国政府法務省

For applicant, part 1 Ministry of Justice, Government of Japan

入国管理局長　　殿Regional Immigration Bureau

　

1　国　籍・地　域 2　生年月日Nationality/Region Date of birth

Family name Given name

3　氏　名Name

4　性　別 ・ 5　出生地 6　配偶者の有無 ・Sex / Place of birth Marital status /

7　職　業 8　本国における居住地Occupation Home town/city

9　日本における連絡先Address in Japan

電話番号 携帯電話番号Telephone No. Cellular phone No.

10　旅券 (1)番　号 (2)有効期限 日 Passport Number Date of expiration Day

11　入国目的 （次のいずれか該当するものを選んでください。） Purpose of entry: check one of the followings

□ Ｉ 「教授」 □ Ｉ 「教育」 □ Ｊ 「芸術」 □ Ｊ「文化活動」 □ Ｋ 「宗教」 □ Ｌ「報道」"Professor" "Instructor" "Artist" "Cultural Activities" "Religious Activities" "Journalist"

□ Ｌ 「企業内転勤」 □ M 「経営・管理」 □ Ｌ 「研究（転勤）」"Intra-company Transferee" "Business Manager” "Researcher (Transferee)"

□ Ｎ 「研究」 □ Ｎ 「技術・人文知識・国際業務」 □ Ｎ 「技能」"Researcher" "Engineer / Specialist in Humanities / International Services" "Skilled Labor"

□ Ｎ「特定活動（研究活動等）」 □ Ｏ 「興行」 Ｏ 「興行」 ■ Ｐ 「留学」 □ Ｑ 「研修」 □ Y 「技能実習（１号）」"Entertainer" "Student" "Trainee"

□ Ｒ 「家族滞在」 □ Ｒ 「特定活動（研究活動等家族）」 □ Ｒ「特定活動（EPA家族）」"Dependent"

□ Ｔ 「日本人の配偶者等」 □ Ｔ「永住者の配偶者等」 □ Ｔ「定住者」"Spouse or Child of Japanese National" "Spouse or Child of Permanent Resident" "Long Term Resident"

□ 「高度専門職（１号イ）」 □ 「高度専門職（１号ロ）」 □ 「高度専門職（1号ハ）」 □ Ｕ 「その他」"Highly Skilled Professional(i)(a)" "Highly Skilled Professional(i)(b)" "Highly Skilled Professional(i)(c)" Others

12　入国予定年月日 日 13　上陸予定港 Date of entry Day Port of entry

14　滞在予定期間 15　同伴者の有無 有 ・ 無 Intended length of stay Accompanying persons, if any Yes / No

16　査証申請予定地 Intended place to apply for visa

17　過去の出入国歴 有 ・ 無 Past entry into / departure from Japan Yes / No

（上記で『有』を選択した場合）　(Fill in the followings when the answer is "Yes")

回数 回 直近の出入国歴 日 日time(s) The latest entry from Day to Day

18　犯罪を理由とする処分を受けたことの有無 （日本国外におけるものを含む。） Criminal record (in Japan / overseas)

有 （具体的内容 ） ・ 無Yes ( Detail: ) / No

19　退去強制又は出国命令による出国の有無 有 ・ 無 Departure by deportation /departure order Yes / No

（上記で『有』を選択した場合） 回数 回 直近の送還歴 日 (Fill in the followings when the answer is "Yes") time(s) The latest departure by deportation Day

20　在日親族（父・母・配偶者・子・兄弟姉妹など）及び同居者 Family in Japan (Father, Mother, Spouse, Son, Daughter, Brother, Sister or others) or co-residents

※

（注） 裏面参照の上，申請に必要な書類を作成して下さい。　Note : Please fill in forms required for application. (See notes on reverse side.)

在　留　資　格　認　定　証　明　書　交　付　申　請　書APPLICATION FOR CERTIFICATE OF ELIGIBILITY

Tokyo To the Director General of

　出入国管理及び難民認定法第７条の２の規定に基づき，次のとおり同法第７条第１項第２号に掲げる条件に適合している旨の証明書の交付を申請します。Pursuant to the provisions of Article 7-2 of the Immigration Control and Refugee Recognition Act, I hereby apply for

the certificate showing eligibility for the conditions provided for in 7, Paragraph 1, Item 2 of the said Act.

年 月 日

Year Month Day

男 女

有 無

Year

Male Female Married Single

student

月1

茨城県つくば市天王台1-1-1　筑波大学　学生部　学生交流課　

029-853-6089 なし

年 月

年 月

Month

"Designated Activities ( Researcher or IT engineer of a designated org)" "Technical Intern Training ( i )"

"Designated Activities (Dependent of Researcher or IT engineer of a designated org)" "Designated Activities(Dependent of EPA)"

月

NARITA AIRPORTYear Month

11 months

2016年

10

Year Month Year Month

から 年

年 月Year Month

Special Permanent Resident Certificate number

続　柄 氏　名 生年月日 国　籍・地　域 同居予定 勤務先・通学先

在留カード番号

特別永住者証明書番号

Relationship Name Date of birth Nationality/RegionIntended to reside

with applicant or notPlace of employment/school

Residence card number

Yes / No

はい・いいえ

Yes / Noはい・いいえ

Yes / No

はい・いいえ

20については，記載欄が不足する場合は別紙に記入して添付すること。　なお,「研修」，「技能実習」に係る申請の場合は記載不要です。Regarding item 20, if there is not enough space in the given columns to write in all of your family in Japan, fill in and attach a separate sheet.

In addition, take note that you are not required to fill in item 20 for applications pertaining to “Trainee” / “Technical Intern Training”.

Yes / Noはい・いいえ

写 真

Photo

40mm×30mm

申請人等作成用 ２　　Ｐ　（「留学」） 在留資格認定証明書用

For applicant, part 2 P ("Student") For certificate of eligibility

21　通学先 Place of study

(1)名　称Name of school

(2)所在地 (3)電話番号Address Telephone No.

22　修学年数 （小学校～最終学歴） 年 Total period of education (from elementary school to last institution of education) Years

23　最終学歴 （又は在学中の学校） Education (last school or institution) or present school

(1)在籍状況 □ 卒業 ■ 在学中 □ 休学中 □ 中退Registered enrollment Graduated In school Temporary absence Withdrawal

□ 大学院 （博士） □ 大学院 （修士） ■ 大学 □ 短期大学 □ 専門学校Doctor Master Bachelor Junior college College of technology

□ 高等学校 □ 中学校 □ 小学校 □ その他 （ ）Senior high school Junior high school Elementary school Others

(2)学校名 年Name of the school Year

24　日本語能力 （専修学校又は各種学校において日本語教育以外の教育を受ける場合に記入）

□ 試験による証明 Proof based on a Japanese language test

（１）試験名 Name of the test （２）級又は点数 Attained level or score

□ 日本語教育を受けた教育機関及び期間 Organization and period to have received Japanese language education

機関名Organization

期間： までPeriod from

□ その他Others

25　日本語学習歴 （高等学校において教育を受ける場合に記入） Japanese education history (Fill in the followings when the applicant plans to study in high school)

日本語の教育又は日本語による教育を受けた教育機関及び期間 Organization and period to have received Japanese language education / received education by Japanese language

機関名Organization

期間： までPeriod from

26　滞在費の支弁方法等 Method of support to pay for expenses while in Japan

(1)支弁方法及び月平均支弁額 Method of support and an amount of support per month (average)

□ 本人負担 円 □ 在外経費支弁者負担 円Self Yen Supporter living abroad Yen

□ 在日経費支弁者負担 円 □ 奨学金 円Supporter in Japan Yen Scholarship Yen

□ その他 円Others Yen

(2)送金・携行等の別 Remittances from abroad or carrying cash

□ 外国からの携行 円 □ 外国からの送金 円Carrying from abroad Yen Remittances from abroad Yen

（携行者 携行時期 ） □ その他 円 Name of the individual Date and time of Others Yen carrying cash carrying cash

(3)経費支弁者 Supporter

①氏　名Name

②住　所 電話番号Address Telephone No.

③職業 （勤務先の名称） 電話番号Occupation (place of employment) Telephone No.

④年　収 円Annual income Yen

――月

Year Month to Year Month

　　　　　　　　　　　―――

――年

――月 から

――年

年 月Year Month to Year Month年 月 から

Japanese language ability (Fill in the followings when the applicant plans to study at advanced vocational school or vocational school

(except Japanese language))

月Month

筑波大学

茨城県つくば市天王台１－１－１ 029-853-6089

(3)卒業又は卒業見込み年月Date of graduation or expected graduation

申請人等作成用 ３　　Ｐ　（「留学」） 在留資格認定証明書用

For applicant, part 3 P ("Student") For certificate of eligibility

(4)申請人との関係 （上記(1)で在外経費支弁者負担又は在日経費支弁者負担を選択した場合に記入）

Relationship with the applicant (Check one of the followings when your answer to the question 26(1) is supporter living abroad or Japan)

□ 夫 □ 妻 □ 父 □ 母 □ 祖父 □ 祖母 □ 養父 □ 養母Husband Wife Father Mother Grandfather Grandmother Foster father Foster mother

□ 兄弟姉妹 □ 叔父 （伯父）・叔母（伯母） □ 受入教育機関 □ 友人・知人Brother / Sister Uncle / Aunt Educational institution Friend / Acquaintance

□ 友人・知人の親族 □ 取引関係者・現地企業等職員Relative of friend / acquaintance Business connection / Personnel of local enterprise

□ 取引関係者・現地企業等職員の親族 □ その他 （ ）Relative of business connection / personnel of local enterprise Others

(5)奨学金支給機関 （上記(1)で奨学金を選択した場合に記入）Organization which provide scholarship (Check one of the following when the answer to the question 26(1) is scholarship)

□ 外国政府 □ 日本国政府 □ 地方公共団体Foreign government Japanese government Local government

□ ） ■ その他 （ ）Others

27　卒業後の予定 Plans after graduation

■ 帰　国 □ 日本での進学Return to home country Enter school of higher education in Japan

□ 日本での就職 □ その他 （ ）Find work in Japan Others

28　本邦における申請人の監護人（通学先が中学校又は小学校の場合に記入） Actual guardian in Japan　( Fill in the following if the applicant is to study at a junior high school or elementary school )

(1)氏　名 (2)本人との関係Name Relationship with the applicant

(3)住　所Address

電話番号 携帯電話番号Telephone No. Cellular Phone No.

29　申請人，法定代理人，法第７条の２第２項に規定する代理人 Applicant, legal representative or the authorized representative, prescribed in Paragraph 2 of Article 7-2.

(1)氏　名 (2)本人との関係Name Relationship with the applicant

(3)住　所Address

電話番号 携帯電話番号Telephone No. Cellular Phone No.

I hereby declare that the statement given above is true and correct.

申請人（代理人）の署名／申請書作成年月日 Signature of the applicant (representative) / Date of filling in this form

年 月 日Year Month Day

※　取次者 Agent or other authorized person

(1)氏　名 (2)住　所Name Address

(3)所属機関等 Organization to which the agent belongs 電話番号 Telephone No.

Attention In cases where descriptions have changed after filling in this application form up until submission of this application, the applicant

(representative) must correct the part concerned and sign their name.

茨城県つくば市天王台1-1-1　筑波大学　学生部　学生交流課　

029-853-8029

以上の記載内容は事実と相違ありません。

注意 申請書作成後申請までに記載内容に変更が生じた場合，申請人（代理人）が変更箇所を訂正し， 署名すること。

　　　　　　　　――― 　―――

　　　　　―――

　――― 　―――

受入れ機関の職員

公益社団法人又は公益財団法人 （JASSO

Public interest incorporated association /

Public interest incorporated foundation

記入例 <Sample>Read the description carefully and fill in all the necessary information.

14. Under "period of stay", please write your intended study or research period at the University of Tsukuba. 滞在予定期間は、筑波⼤学での在籍期間を書いてください。

17. Under the field “Past Entry into/departure from Japan”, write the number of entries into Japan in the past, if any, and the latest period of stay. If you fail to report the accurate record of entry, the certificate of eligibility will never be issued. In the worst case scenario, you will not be able to enter Japan for years to come.出⼊国歴は、過去の⽇本への出⼊国の回数と直近（最近）の出⼊国期間を正確に記載してください。記載内容に虚偽があると、在留資格認定証明書は交付されません。また、今後⽇本への⼊国を認められないことがあります。20. If you have a family or co-residents in Japan, write their names and other information. If you donʻt have any family in Japan, just write “NONE”under the field “Family in Japan or co-residents”.⽇本に親族または同居者がいる場合には名前、その他の情報を記載して下さい。いない場合は「NONE」と記載してください。

10. Write the passport number and date of expiration. If you have applied for one and you are presently waiting for its issuance, just write "Application submitted" パスポート番号と有効期限を記載してください（パスポート申請中の場合は「申請中」と書いてください）。

5&8.Write the name of the city and country under the “Place of birth”. About “Home town/city,” please write the complete address. And for Chinese students, please write in Kanji.出⽣地には都市名まで記⼊すること。本国における居住地は詳細に記載して下さい。 （○○省○○市＜県＞〜○号）また、中国⼈は漢字で記⼊すること。

16. Please make sure to write the city name of the place where you are planning to apply for a visa. Regarding the city name, please refer to the following URL. 審査予定地の都市名を必ず記⼊して下さい。審査予定地リストは以下のURLを参考にして下さい。http://www.mofa.go.jp/about/emb_cons/over/index.html

Photo: Please submit your photograph (4 cm×3 cm, clear background, and with your name and nationality written on the back of the photograph) along with your application. Do not paste it onto the application.写真（縦4cmx横3cm、無背景、裏に名前と国籍を記⼊）は、貼り付けずに、申請書と⼀緒に提出して下さい。

3. Write your name in alphabet as written in your passport.パスポートに記載されているとおりのアルファベット表記名を記⼊すること。

22. Write the total period of education from elementary school to the current education institution where you will graduate in your country.⼩学校から本国の在籍教育機関を卒業するまでの修学年数を書いて下さい。

23. Check the field that matches your last student status and institution.Write the name of the institution and the (expected) date of graduation.あなたの最終学歴の在籍状況と課程にあてはまるものにチェックし、学校名と卒業（予定）年⽉⽇を記⼊してください。24. For those who took an examination that certifies their Japanese language ability, write the name of the examination and the acquired class or score. In addition, send a copy of the certificate.⽇本語能⼒を証明する試験を受けた者は、試験名と、取得級⼜は点数を書いてください。また、その証明書の写しを⼀緒に送ってください。

26(1)&(2) . Write the average amount of support per month and also how the supporter will send money for your cost of living and tuition fee in Japan. For scholarship recipients, check the field and also write the amount of the scholarship per month. If you are nominated as a recipient of JASSO scholarship, the stipend is 80,000 yen per month.滞在費（⽣活費・学費）の送⾦⽅法にあてはまるものにチェックしてください。また、その⽉額（平均）を記載してください。奨学⾦を受給する場合は、チェックしてください。また、その⽉額を記載してください。 JASSOの奨学⾦は⽉額8万円です。Estimated costs of attending the University of TsukubaThe following table provides the estimated average costs of studying and living in Tsukuba, including books and supplies, tuition fees, health insurance, and other necessary expenses.

26(3). Write your supporterʻs name, address, occupation, telephone number and annual income. If you are nominated as a recipient of JASSO scholarship, you do not need to fill out this field.経費を⽀払う⼈の⽒名、住所、職業、電話番号及び年収を記載してください。JASSOの奨学⽣として推薦されている学⽣は、ここは記⼊する必要はありません。

※The amount of your supporterʼs annual income must be equivalent to the amount certified by the enclosed Certificate of Income. (We do not consider income that cannot be certified as annual income.)経費⽀弁者の年収額は同封する収⼊証明書の⾦額と⼀致していること。（証明できない収⼊は年収として認めません。）

Please attach the certificate of Attendance and academic record (including students admitted in exchange program) if you stayed in school in Japan (Japanese language school etc.) before enrolling in our university.本学に⼊学する前に⽇本国内の学校（⽇本語学校を含む）に在籍した者は、その出席証明書及び成績証明書を⼀緒に送ってください(交換留学による在籍を含む）。

Duration of study Without tuition waiver With tuition waiverOne semester 868,000 yen 600,000 yenTwo semester 1,736,000 yen 1,200,000 yen

26 (4). Check the corresponding relationship between you and your supporter.申請⼈と経費を⽀払う⼈との関係をチェックしてください。

26(5). For scholarship recipients, write down the name of the scholarship. If you are a recipient of the JASSO scholarship, please check the field of “Others” and write “JASSO”.奨学⾦を受給する場合は、奨学⾦名を記⼊してください。 JASSO奨学⾦受給者は、その他を選んでJASSOと記⼊して下さい。

27. Check the field that matches what you plan to do after completion of the course you have been admitted to.⼊学を認められたコースを修了した後の予定についてチェックしてください。

29. If you request our university to apply for the certificate on your behalf, DO NOT WRITE HERE. (We will fill in these fields.)⼤学に代理申請を依頼する⼈は記⼊しないこと。（⼤学側で記⼊します。）