CSPAMEXT

Comparative Studies in Politics and Administration in Asia (CSPA)
No.

Application Form
1. APPLICANT INFORMATION
Last NameFirst Name

PhotographMiddle Name(size: 4.5cm x 3.5cm)-Bare-headed,full-faced-Displaying upper body
-Taken within the past 6months.

GenderMaleFemale

Nationality

If it is difficult to paste
here, please attach thephoto to E-mail.

Date of Birth
Age
Phone
E-mailContact Address

2. EDUCATION HISTORY
From - To

Elementary School

From - To

Secondary School (1)From - To

Secondary School (2)CSPAMEXT

From - To

Higher EducationMajor

Degree Awarded

From - To

Higher Education

Major

Degree Awarded

Total Years of SchoolingYears

3. EMPLOYMENT HISTORY
From - To

Name & Address of Employer

Position

From - To

Name & Address of Employer

Position

4. ENGLISH ABILITY (Please indicate your TOEFL [or equivalent] score)

5. RESEARCH PROPOSAL
Proposed Topic:

Topic: (Two A4 pages, Separate sheet)

CSPAMEXT

6. Financial Plan during you study

7. Emergency Contact in Your Home Country
1) Name:Relationship

Address:
Phone

Email:

2) Name:Relationship

Address:
Phone

Email:

8. SCHOLARSHIP
Do you wish to be considered for a Japanese Government Scholarship?

Yes

No

If you do not receive a Japanese Government Scholarship, are you willing to privately
finance your studies at Kyushu University?

Yes

No

9. DECLARATION & SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
I have read and understood the Privacy Policy for Students Applying for Admission at Kyushu
University available at:
http://www.kyushu-u.ac.jp/en/website/privacypolicy/internationalstudents
If this application leads to my enrolling at Kyushu University, I understand that false or misleading
information in this application may result in my enrollment at Kyushu University being terminated.

SignatureDateCSPAMEXTRECOMMENDATION LETTER 1
To: President of Kyushu University※To the RECOMMENDER: Please write a statement concerning the applicant, stating how long and in what
capacity you have known him/her, your evaluation of his/her intellectual capability and personal character,your appraisal of the applicants’s promise of completing the graduate program in English.

On behalf of (Name of Applicant):
First Name

Middle Name

Last NameCSPAMEXTRECOMMENDATION LETTER 2
To: President of Kyushu University※To the RECOMMENDER: Please write a statement concerning the applicant, stating how long and in what
capacity you have known him/her, your evaluation of his/her intellectual capability and personal character,your appraisal of the applicants’s promise of completing the graduate program in English.

On behalf of (Name of Applicant):
First Name

Middle Name

Last Name

CSPA

MEXT

CONFIDENTIAL

IMPORTANT: Please evaluate the applicant’s qualification, compared with the last 5 years students, bychecking the appropriate space below, and specifying first the group with which you have compared him/her.

Intellectual capacity

excellent

good

Averagebelow

Reading and writingskills

excellent

good

Average

below

Presentation skills

excellent

good

Averagebelow

Overall potential

excellent

good

Average

below

Date

Signature

Name:

Position

Institution

Relationship toApplicant

Address

Phone Number

EmailWe appreciate the time and effort that you have taken to provide us with these comments.
Please return this letter directly to Kyushu University OR place in a sealed envelope and return to the candidate.
Address: Admission Office of International Programs
Faculty of Law, Kyushu University
744 Motooka, Nishi-ku, Fukuoka, 819-0395 JAPAN