（Form 1-1）

Application for enrollment fee waiver (deferral of payment) and tuition fee
waiver for the 2023 academic year (first semester)
Applicant FormApril 1 2023

To the President of Kanazawa University

I wish to apply for an enrollment fee waiver (deferral of payment) and tuition fee waiver for the 2023 academic year, andattach the required documents.
Enrollment fee waiver
Application Category(Check one)

□ Application for anenrollment fee waiver□ Application for deferral ofenrollment fee payment□ Application for the Firstsemester only

□ Combined application for the□ Not applicablefirst and second semesters(Only students enrolled in the graduate
school or Bekka may select)

Tuition fee exemption
Application Category(Check one)

Application Category □ General
Registration oftuition transfer□□ Not applicable(Undergraduate, Graduate, and Bekka
students may select)□ Self-supported individual□

International student

You need to go through the account transfer procedure even if you
apply for tuition fee exemption.
Address
Contact details

RegisteredName
Zip code:

-TEL:

－

Mobile:－－－Email ：
ApplicantAffiliation (Fill in the department you plan to enroll.)

Student classification□College of＠Academic year.

□ ApplicableYear □ Not
applicable

School of.
□ Bachelor's□ General Education Division of the Institute of Liberal Arts andDegreeScience (□Humanities□Sciences）

Graduate School of□ GraduateSchool□ Master's/PhD First semester□ PhD/Post-doctorate□ Doctor of Medicine/Pharmacy______Year□ Professional Degree Program.
.

Division of(Column to be completed by Bekka students)

Emergency contact
information

Name

Address
Zip code:

Contact details-TEL:－Mobile:(Relation:

Transfer category－－－(International students should provide a) Japanese contact living at a separate address) Email ：＠Reasons for Application(To be filled out in detailed and specific terms by the applicant in his/her own handwriting)

Where the main income earner is unemployed
or seeking work

Duration of unemployed(seeking work)

DateYearMonth -Academic history

Year

MonthHigh School/Technical College/Junior College□Graduate□Anticipated Graduation□Withdrawal

Year

MonthUniversity□Graduation□Anticipated Graduation□Withdrawal

Year

MonthGraduate School□Master's

Applicant's part-time workand employment status

Generalstudent/Internationalstudent
Employed person(Working adult, selfsupported, etc.)

Faculty

Postgraduate Program□PhD First semester）□Completed □Anticipated completion

Ongoing part-time job

Ordinary employment

For questions with a "□," please check the appropriate box.

□Yes
□Have previously worked Last day worked(YearMonth□No□ Yes□No Last day worked（YearMonth))

(Form 1-2)

FuriganStudent number

Name

ApplicFamily menbers living together in Japan onlyNameRelation*AgeCompany nameYears of employment(1) Family members
excluding persons in school

Applicant＊Date～

Father＊Date～

Mother＊Date～＊Date～＊Date～＊Date～＊Date～

Relation

Classification(2) HouseholdincomeSalaryincome
Nonsalary
income(Yen)

Salary income, wages, bonuses, executive
compensation

Father(Yen)(Yen, thousands)

Mother(Yen)(Yen, thousands)

(Yen)

(Yen)

Notes

Pensions and benefits
Self-employed (Commerce / Industr

Rent / Ground rent / Dividends
Other ((3) Applicant

Commutingclassification
Scholars□ Living at
hiphome(per□ Livingmonth)away fromhome

Relation

Applicant<- Do not complete fields in blue
Total salary
Total non-salary incomeName)(currentyear)(Lastyear)():□ Payment □ Loan) yen per month x () months):□ Payment □ Loan) yen per month x () months):□ Payment □ Loan) yen per month x () months):□ Payment □ Loan) yen per month x () months(((((((Type

Enrolled in school

Value received(Yen, thousands)(Annual value)

Commutingclassification(Year of admission) (School year)(4) Persons enrolled in study(Excluding the applicant)□Elementary school □Junior High School □High School □University□Special vocational school (High school course)□Living at home□National □Technical College□Public(Age: Years) □Private□Living away fromhome□Special vocational school (Specialized course)
Name of school(Year of admission) (Year:) City (□Elementary school □Junior High School □High School □University□Special vocational school (High school course)□Living at home□Special vocational school (Specialized course)□Living away fromhome□National □Technical College□Public(Age: Years) □Private

Name of school(Year of admission) (Year:□Elementary school □Junior High School □High School □University□National □Technical College □Special vocational school (High school course)□Public(Age: Years) □Private
Single parent household(5) Special
exemptionsHouseholds with disabled
persons
Households affected bydisasters, storm and flood
damage, theft, etc.

)

) City (□Living at home
□Living away fromhome□Special vocational school (Specialized course)
Name of school□No father□Death□ Separation□No mother□Death□ Separation(Year of admission) (Year:(YearMonth)(YearMonth)

Relation () □ Disabled□ A-bomb Survivor (with disability) Certification number ()Relation () □ Disabled□ A-bomb Survivor (with disability) Certification number ()) City ()0: Not applicable

1: Applicable

Persons

Value of damageNature of damage¥

Family members

Field to becompletedby the university

For questions with a "□," please check the appropriate box.

)

Persons

Self-supported 0: No ・ 1: Yes
Household inreceipt of public

Checked

0: No ・ 1: Yes
EnteredVerification

Application for enrollment fee Waiver (Deferral of payment )The application form for the enrollment fee waiver (deferral of payment) and tuition fee waiver is an important document in theselection process. Please read these instructions carefully and fill in all relevant information so that we can understand yourcurrent situation as of April 1.Please note that your application may not be accepted if you do not fill in the form. Please notethat if the information entered is found to be incorrect, any current waiver permission will be revoked and any future waiver
applications rejected, so please take care to enter information accurately.You may apply for both the "Enrollment fee waiver(Deferral of payment)" and the "Tuition fee waiver" using this form. Please be sure to put a check against the relevant items forwhich you are applying: "Application for enrollment fee waiver" and/or "Application for tuition fee waiver". Students whowish to apply for both the enrollment fee waiver (deferral of payment) and the tuition fee waiver may submit only one copy of
the application form for the Enrollment fee waiver (Deferral of payment) and Tuition fee waiver (Forms 1-1 and 1-2), together
with documents such as a certificate of income and a copy of tax withholding certificates.
（Form 1-1）

Application for enrollment fee waiver (deferral of payment) and tuition fee
waiver for the 2023 academic year (first semester)
Applicant Form

Only students enrolling in the graduate school or on
April 1 2023
a Bekka students may apply for the "Enrollment fee
To the Presidentwaiver."Undergraduateof Kanazawa Universitystudents are not eligible for
Whenforapplying
foracademica tuition year,
fee waiver,I wish to apply forenrollmentfee
fee waiver,
waiver (deferralof payment)
and tuition fee waiverthe 2023
andtheanenrollment
those wishing
to apply
pleasecheck"Applyingfor
thesecondattach the requiredshoulddocuments.
complete the "Deferral of enrollment fee
semester only".
payment"
form. for an enrollment fee□ Application□ Application for deferral of enrollment fee
Enrollment fee waiver
Application Category(Check one)
Tuition fee exemption
Application Category(Check one)
Application Categorywaiver(Only students enrolled in the graduate
school or Bekka may select)□ Application for the First
semester onlypayment(Undergraduate, Graduate, and Special
Course students may select)□ Combined application for
the first and second semesters□ General

Registration of tuition□transfer accountName□ Self-supported individualRegistered□ Not applicable□ Not applicable□

International student

You need to go through the account transfer procedure even if

Please checkthe forapplicantyou apply
tuition categories
fee exemption.
detailedAddressin the application guidelines and Contact details
then put a -check mark in theTEL:
appropriate －Zip code:－category.

ApplicantIf you haven't registered yet,－－Mobile:please register immediately. If＠Email ： you plan
you cannot make an accountFill in the department
Studentclassification
Affiliation (Fill in the department youto
planto enroll.)
Academic year Transfer categorytransfer
due to someenroll.

.
□ College of□ ApplicableSchoolof.
□ Bachelor'sYear□Not□ General Education Division of the Institute of Liberal Arts andDegreeapplicable
Science (□ Humanities□ Sciences）□ Master's/PhD First semester
Graduate School of.
If your parents
cellphones, please provide□ have
PhD/Post-doctorate□ numbers.
Doctor of Medicine/Pharmacy
their cellphone
This will only be used
□ Graduate Sch Division of.
Year(Column to be completed by Bekka students)for communications from the university.
□ Professional Degree Program

Emergency contact
information

Name

Zip code:(Relation:Address-TEL:
Mobile:(International students should provide a) Japanese contact living at a separate address) Email ：Contact details－－－－＠Please provide your parents' contact information. ThisReasons for Application (To be filled out in detailed and specific terms
by yourthe applicant
in his/herownwill beemergencycontactin handwriting)the event you

cannot be reached.
For international students, please indicate a family
member who lives with you (e.g., spouse) or a person
who lives in Japan and whom you can contact. In suchcases, please be sure to obtain the consent of theperson to be listed as a contact person before
providing their details on this form.

Detailed and specific reasons of thecircumstances surrounding the application are
to be provided by the applicant themselves inthe "Reasons for application" column.

Where the main income earner is unemployed or
seeking work

Please complete this form so that we canunderstand your circumstances prior to enrollment.

Duration of unemployed(seeking work)

DateYearMonth -AcademichistoryYear

MonthHigh School/Technical College/Junior College□Graduate□Anticipated Graduation□Withdrawal

YearMonthUniversity□Graduation□Anticipated Graduation□Withdrawal

YearMonthGraduate School
Postgraduate Program（□Master's□PhD First semester）□Completed □Anticipated completion□YesGeneral□Have previously worked Last day worked
student/InternationalOngoing part-time job(YearMonthstudent□NoEmployed person□ Yes(Working adult, self□No Last day worked(YearMonthOrdinary employmentsupported, etc.))

Applicant's part-time workand employment status

For questions with a "□," please check the appropriate box.

Faculty)Application for Enrollment Fee Waiver (Deferral of payment ) andStudent number

Name

Students enrolling in April 2023 do not need Nameto enter their student ID number.

Name NameRelation(Form 1-2)

FuriganAge*<- Do not complete fields in blue
Total salary
Total non-salary income

Company name Years of employment (Yen, thousands)(Yen, thousands)

ApplicantPlease record all family(1) Family members
excluding persons in school(2) Householdincome(3) Applicant＊Date～Please enter the name of the company
memberslivinginthesame＊Date～they work for (e.g. XX company) andFather
household as you and yourthe dates of employment. If they are
If unemployed for reasons＊Date～
Mother parents.
self-employed, please write (selfsuch as being a homemakerBe sure to include any＊Date～employed) next to the company name.
or a pensioner, pleaseenter
family members who are
If the applicant (the student) has a"unemployed."＊Date～
dependents of your parents
regular job, please record the company
If you are making a repeat＊Date～
name in lieu of "student."
for tax purposes, even if
application (preparatory
Students who do not have a regularthey live separately.
school student), please＊Date～
job should enter "student."
record"reapplying
Siblings who live separately
Applicant Father
MotherRelation
Notes
(Yen)
(Yen)
(Yen)
(Yen)
(Yen)
due to marriage,
Classification
Salary income, wages, bonuses, executive
or other
Salary employment,compensation(2) Please record your family's income listing each source of income.
income reasons do not need to bePensions and benefits
included on this form.
Since the number of
Self-employed (Commerce / IndusEven
if such siblings do live
Nonmonths' benefit received
Please record details of anywithyou,
they needbeRent/ Ground
rentnot/ Dividends
salarydiffers depending onscholarships you received last year
income included if they handle theiremployment, please check(April 2022 - March 2023). However,
Other ()
own finances.
before completing Value
this received
freshmen should not enter details ofCommuting():□ school
Paymentor□ Loan section.
scholarships received in high(Yen,( college.) yen per month x () months
classification(currenttechnicalthousands)□ Living athome□ Living
away fromhome(4) Persons enrolled in study (Excludingthe applicant)Relation

Scholars
hip(permonth)year)(((Lastyear)():□ Payment □ Loan) yen per month x () months():□ Payment □ Loan) yen per month x () months((Annual value)):□ Payment □ Loan

Please check the "living at homearemonthself-supportedfor( box" if) you
yen perx() months
any reason, such as living apart from your spouse.
NameType students
Enrolled
in required
school to(Yearof admission)
All international
are also
checkthe "Living at(School year)
home" box.

(Age:□Elementary school□Junior High School □High School □University□Special vocational school (High school course)□Nationa□Technical College□

Public □Special vocational school (Specialized course)Years) □Commutingclassification

Private Name of school(□Living at home
□Living away fromhome

Year of admission)

City ((Year:)(5) Special exemptions□Elementary school □Junior High School □High School □University
Enrollment in a general course in□ Nationa□Technical College □Special vocational school (High school course)□Living at homea trade school or various other□Living away from□ Public □Special vocational school (Specialized course)
types of school (preparatory
If you are homeliving in an )For single-parent households,
Private Name of school(Year of admission) (Year:Years) □(Age: training
City (school, vocationalschool,apartment or dormitory
theappropriateboxSchool □University□Elementaryplease
school check□JuniorHighSchool □Highother) will not be treated as□ Nationa□Technical Collegeat homeaway from□Living
your parents,□Special
vocational
school (High school course)fordeathofspouseorseparation,studying, so please record these□Living away fromplease check the box forand record
the date ofcourse)
death orschool (Specialized□ Public □Special vocational
homeunder column (1) Family membersfrom( the )separation.
□ Private Name of school(Year of admission) living(Year: awayCity(Age: inYears)
excluding persons
school.
family homeand fill in the0: Not applicableMonth)□ No fa □ Death□ Separation (Yearname of the municipality
Single parent household
1: Applicable□ No m □ Death□ Separation (YearMonth)in whichyoulive.
Households with disabled
persons
Households affected bydisasters, storm and flood
damage, theft, etc.

Relation () □ Disabled□ A-bomb Survivor (with disability) Certification number ())

Relation () □ Disabled□ A-bomb Survivor (with disability) Certification number ())

Nature of damage

Please record the natureof your relationship andtheir certification number.

Persons

Value of damage¥

Field to becompleted bythe university

Family members

Persons

0: No ・ 1: Yes
Self-supported
If you have suffered a disaster such as fire, windstorm, flood, or theft
within one year
prior to enrollment, please fill out this form attaching a record of disaster.
Household in re0: No ・ 1: Yes

For questions with a "□," please check the appropriate box

CheckedEnteredVerification