OITA UNIVERSITY

APPLICATION FORM FOR

INTERNATIONAL PROGRAM AT OITA UNIVERSITY (IPOU)

FOR SPRING & FALL ENTRIES 2015-2016

INSTRUCTIONS

1 This form should be completed in English.

2 Numbers should be in Arabic figures.

1 Full name (In your native language)

(Last name)

(First name) (Middle name)

In Roman block capitals

(Last name)

(First name) (Middle name)

2 Sex FemaleMale

3 Nationality

4 Date of birth (Month)

(Day)

(Year)

Address

Telephone number:

Fax number:

Email address:

Home institution

Name:

Faculty:

Academic year (at the time of application): First / Second / Third / Fourth / Postgraduate

. Period of Stay

6 months1 year

From April 2015 to August 2015 From April 2015 to February 2016

From October 2015 to February 2016 From October 2015 to August 2016

Japanese language background

(1) Name of the institution where you study or have studied Japanese:

(2) Period of Study From to

(3) Total hours of Japanese language study:(4) Japanese Language Proficiency Test (If you have passed it, indicate the Level):

N1N2N3N4N5

. English language background (If your native language is not English).(1) Name of the institution where you study or have studied English:(2) Period of Study From to

(3) Total of hours of English language study:(4) TOEFL score:

Other recognized score (Quote name):

(5) Have you lived in an English-speaking country? (Please circle) YES/NO

If YES,in which country? for what period? in what capacity?

10. Financial Resources and Support

Are you applying for any scholarships? (Circle one of the following.)

__ Yes, a scholarship/award has already been allotted to me.

Title of the scholarship or other award: Total amount:

__ Yes, I am applying for a scholarship.

Title of the scholarship or other award: Total amount:

The date on which you will receive a final answer: __ No, Im not applying for any scholarship.If you do not receive any scholarship/award, what will be your main source of income, while you are studying in Japan? Study Plan at Oita University1) Would you mainly like to study the Japanese language and socio/cultural subjects (taking courses offered through the Center for International Education and Research) at Oita University? YES / NO

2) If NO, specify the subjects (or areas) you would prefer to study at Oita University.

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3) Please summarize your study plan at Oita University.

4) List all of the courses that you intend to take or would like to take at Oita University.

Statement of Purpose

Please indicate the extent to which your coursework and personal and/or educational experience have prepared you to participate in the International Program at Oita University.

Field of Study at Home Institution Please describe your education at your home institution, indicating your majors, minors, the detailed focus of your studies, and so forth.

I certify that to the best of my knowledge and belief the above statements are true.

Date of application :

Applicant's signature :Applicant's name in Roman block capitals :

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