Kagoshima University Graduate School ofMedical and Dental SciencesExamination Fee Payment Confirmation SlipApplication No.

NameA payment at convenience storesA payment with your Credit Card1. Payment at a convenience store2. Payment by credit card1https://e-shiharai.net/23https://e-shiharai.net/ApplicationnumberTime of Entrance:(Month/Year)(/)Application for Admission to the Medical Sciences Course (Master Course) ofKagoshima University Graduate School of Medical and Dental Sciences(ApplicantclassificationFull nameForeign-student ApplicantsLastRomanized letters orEnglishMiddle()(Month/Date/YearDate of birth/Research department towhich you are applyingName of prospectivesupervisor/)MaleFemaleNationality/

First choiceSecond choice

Third choiceFirst choiceSecond choice

Third choiceSemester Planning to RegisterTest Method)From October 2022From April 2023face-to-face / remoteCircumstances in which remote testing is necessary:UniversityNIAD-QEName of institution attended(Field of study / Area of focus/Date of graduation (or expected date))(/):Date of completion (or expected date) of bachelor's degree:Bachelor's degree in ()OtherType of licenseMedical science-relatedlicense obtained, yearobtained, license number

Month/Year(License number:)Month/Year(License number:)Month/Year(License number:)Month/Year(License number:)Current address (Address towhich the letter ofacceptance can be mailed)Phonee-mail addressEmergency contact(Note: Address other thancurrent address)Phone(Remarks)1. Leave the field marked " " blank.
2. Fill in the blanks and circle the appropriate category.
3. Only applicants applying to two or more departments are required to fill in their second and third choice programs and the names of their prospective
supervisors.
4. Applicants with a national exam license related to the medical sciences field should be sure to indicate it.
5. Complete the reverse side of this application form.[Reverse side of application form]Personal HistoryEducation backgroundYear and Monthof Entrance andCompletionName and Address of SchoolAmount of timespent at theschool attendedElementary EducationName

FromyearsElementary SchoolLocationTo

andmonthsSecondary EducationName

FromyearsLower Secondary SchoolLocationTo

andmonthsUpper Secondary SchoolName

FromyearsLocationTo

andmonthsHigher EducationName

FromyearsUndergraduate LevelLocationTo

andmonthsGraduate LevelName

FromyearsLocationTo

andmonthsTotal years of schooling mentioned aboveDiploma or Degree awarded,Major subjectyears

and monthsProfessional backgroundName and address oforganizationPeriod of employmentPosition

Type of workfromtofromtoAwards/penaltiesMonth/Year/Month/Year/I hereby certify the above information to be correct.
Date:Name:Note 1: Please provide as much detail as possible with regard to your personal history.
Note 2. List your educational background chronologically starting with senior high school (Japanese applicants) or elementary school (international exchange
applicants).
Note 3. Attach a separate sheet if more space is needed for your personal history information.Time of Entrance:

Month/Year)/Photo SlipPhoto Form for the Medical Sciences Course (Master Course) ofKagoshima University Graduate School of Medical and Dental SciencesApplication numberApplicant classificationResearch department towhich you are applying(Name of prospective
supervisor)Foreign-Student ApplicantsFirst choiceSecond choice

Third choiceFull nameForeign languageEnglish for Foreign-Student ApplicantsEssay
Test MethodEnglishface-to-face/ remoteRemarks:2. Fill in the blanks and circle the appropriate category.
3. Only applicants applying to two or more departments are required to fill in their second and third choice programs.
Do not detachTime of Entrance:

Month/Year)/Photo Slip An Admission ticketPhoto Form for the Medical Sciences Course (Master Course) ofKagoshima University Graduate School of Medical and Dental SciencesApplication numberApplicant classificationResearch department towhich you are applying(Name of prospective
supervisor)Foreign-Student ApplicantsFirst choiceSecond choice

Third choiceFull nameForeign languageEnglish for Foreign-Student ApplicantsEssay
Test MethodEnglishface-to-face/ remoteRemarks:2. Fill in the blanks and circle the appropriate category.
3. Only applicants applying to two or more departments are required to fill in their second and third choice programs.
Do not detachTime of Entrance:(Month/Year)(/Application number)Research Proposal for the Medical Sciences Course (Master Course) ofKagoshima University Graduate School of Medical and Dental Sciences()Research department to which you areapplyingName of prospective supervisorFull namePlease describe your research proposal below, including research theme, goals and objectives, and research justificationand content.

Note: Use this sheet to write a proposal of around 350 words in length. If you are using a computer, follow the format ofthis sheet (A4 size).Kagoshima University Graduate School ofMedical and Dental SciencesExamination Fee Payment Confirmation SlipApplication No.

NameA payment at convenience storesA payment with your Credit Card1. Payment at a convenience store2. Payment by credit cardhttps://e-shiharai.net/1https://e-shiharai.net/

23From October 2022e-mail Address:From April 2023Name and Address of SchoolYear and Monthof Entrance andCompletion(Name(Amount of timespent at theschool attended)

Fromyears

Location()ToandmonthsName(

Fromyears

Location()To

andmonthsName(

Fromyears

Location()To

andmonthsName(Fromyears

Location()ToandmonthsName(

FromyearsToandmonths)Diploma or Degree awarded,Major subjectElementary Education()Elementary School)Secondary EducationLower Secondary School)Upper Secondary School)Higher EducationUndergraduate Level)Graduate Level
Location()Total years of schooling mentioned aboveName and address of organizationyearsPeriod of employmentPositionType of workFrom
ToFromTo(Date of application:Applicant's signature:and months)NameName and describe the research theme of your interest.

Fill in the following where applicable. Please submit evidentiary documents or materials (photocopiesaccepted) for the qualifications or experiences you have indicated.
Date obtained Qualifications/licenses(Month/Year)

Achievements (papers published, presentations at academic conferences, etc.)For papers, list author's name, paper's title, publication name and volume, first and last page numbers,publication year.
For presentations, list presenter's name, title, format (e.g., oral, poster), conference title, presentation date.

PeriodResearch-related training and other activitiesMonth/Year Month/YearPeriodStudy abroad and other international experienceMonth/Year Month/YearOther information you consider to be relevant (academic society membership, etc.)Attach a separate sheet (or a photocopy of this sheet) if additional space is needed.(1) 20 minutes walk from Wakida tram stop, TaniyamaLine Kagoshima City Tram(2) 20 minutes walk from Usuki Station, JR IbusukiMakurazaki Line(3) Take No.14, No.17, No.18, No.19 of Kagoshimakotsu Bus and get off at “Daigakubyoin-mae”.
*After getting off the city tram or JR, the DaigakubyoinLine No.18, of Kagoshima City Bus (Shuttle Bus:Wakida to Sakuragaoka) is available at Wakida tramstop or Usukisyogakko-mae.