FOR OFFICIAL USE

Application No:
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and taken within 3 months

APPLICATION FOR ADMISSIONTHE ENGLISH ENGINEERING EDUCATION PROGRAM (e3)
GRADUATE SCHOOL OF ENGINEERING
HOKKAIDO UNIVERSITY☐ MASTER’S PROGRAM☐ DOCTORAL PROGRAM
Desired enrolment:☐ April 20☐ October 20

INSTRUCTIONS: Please type in the application. If handwriting, please write neatly in capital blockletters.
 Attach all the necessary documents specified in the list of application documents.
 Unclear or incomplete application without proper explanation will not be considered.

☐Male☐Single☐Female☐Married(1) Name (in Roman letters)

Surname/Family nameFirst nameMiddle name(2-2) Do you possess Japanese nationality? ☐ Yes, I do.

(2-1) Nationality☐ No, I don’t.

(3) Date of Birth (DD/MM/YYYY)(4) Current Address
Zip code:

Address:Phone

E-mailAll the announcements will be sent by e-mail. Please make sure to provide a correct and valid e-mail address which
can be used for the whole period of your application.

(5) Permanent Address
Zip code:

Address:Phone

E-mail(6) Potential Supervisor
Please write down the names of one or two faculty members (professors/assoc. professors) and their laboratories
OR the names of two laboratories that you want to be considered for admission (in priority order)
Professor’s nameName of the Laboratory
Division
1st choice
Laboratory of
2nd choice

Laboratory of☐ I agree to be considered for acceptance by a different supervisor/laboratory.

(7) The Title of Research Proposal
Please write down the title of your planned research and attach a research proposal (in details if you are applying fora doctoral program). If the two professors or laboratories you have chosen deal with different research topics, pleasewrite down two research tittles, and attach two corresponding proposals.
(i)
(ii)

(8) Educational BackgroundYou shall prepare official academic transcripts (complete or the most recent by the time of your application if yourstudy is still in progress) and your graduation or expected graduation certificate. If your rank is not indicated therein,
an official ranking certificate is necessary.
If you have spent a semester or more on exchange program in another university, currently enrolled as research
student, have additional qualifications etc. please specify it in the section “others”

Institution, Name of theUniversity

Major Field

Bachelor’s

Master’s

OthersPeriod ofenrollment(month/year)

From/

to/

From/

to/

From/

to/

Type ofDiploma/
DegreeawardedFinalGrade(GPA)

Rank inClass ifany(rank/totalstudents)(9) Employment Record Please begin with the most recent employment.
Period ofemployment(month/year)

Organization, city, country

From/

to/

From/

to/

Position

Type of work, brief description(10) List of Publications and Graduation Thesis
If you have any publications please write down a full reference information including the name(s) of the author(s),title, publisher, date of publication, pages. When DOI is available, please include it. Attach abstracts and/orreprints.
Bachelor’s thesis title:
Master’s thesis title:
List of publications (If the list is too long, please attach a separate sheet):123

(11) English Proficiency
Please attach a score certificate or a medium of instruction certificate.

TOEFL, IELTS, TOEIC or other standardized English test score obtained within two years.
TestScore

Date taken (DD/MM/YYYY)☐ I have requested my TOEFL/IELTS score to be delivered directly to the e3 program’s office.

For applicants who completed full time degree in English and/or are native speakers:☐ I completed a full-time degree program which language of instruction was English.
☐ I am a native speaker of English.

(12) Have you been awarded any scholarship, grant, award or prize in the past?
If yes, please provide the details.
The name of scholarship, grant, award,prize etc

Awarding organization/fundPeriod(month/year)

From/

toFrom//to/

Explain briefly about thescholarship, etc.

(13) Are you applying for other graduate schools and scholarships?
Please rest assured that this information doesn’t affect your chances to be selected.
☐ Yes (Please fill in the details below)
UniversityScholarship/Grant

Country

Expected date of theresults announcement☐ No(14) How do you plan to support yourself during your study program?
☐ I’m applying for or was awarded a scholarship/educational loan:☐ Japanese government (MEXT) scholarship (Embassy recommendation)☐ Japanese government (MEXT) scholarship (Other).
Please specify the type:☐ Chinese Council Scholarship (CSC)☐ JICA Scholarship
Please specify the type:☐ Other (please specify the details below)
Name of theorganization

scholarship(loan),

Status of the application (going toapply/nominated, etc)

Application
deadline

Expected date of theresults announcement(Please attach the scholarship information form and, if already nominated, a confirmation letter)☐I will primarily bare all the expenses by myself/ will be supported by a sponsor (even if not awarded a scholarship).
Please attach the international applicant’s declaration of Finance. If you wish to enroll even if your scholarship
application didn’t succeed please tick this option too. Self-funded applicants may qualify for such a support as Honors
Scholarship, tuition fee discount/waiver and study support for PhD students. Please check program’s page for details.
☐Other (specify)

(15) Referees
You shall request for the recommendation letters by yourself. If it’s not attached to your application please tick therelevant box. Please make sure that the recommendation letters sent by referees directly to the program’s office canarrive before the deadline.
(i) Name:
Position:☐ I have requested the referee to send the letter directly to the program’s office.
(ii) Name:
Position:☐ I have requested the referee to send the letter directly to the program’s office.

E-mail:E-mail:(16)

How did you know about our program?
We would appreciate if you not only tick a box, but also provide some further details.
☐1.e3 home page☐3.During an internship/exchange program at HU☐5.Was advised by peers/senior students☐7.At a study abroad/ study in Japan fair etc.
☐9.Other☐2.Met professors/students from HU at international event etc.
☐4.Was advised by the supervisor at home university☐6.Saw a brochure/announcement at home university☐8.Checked related to study abroad or Japan resources online

Additional details:(17)

Contact person in your home country

Name:

Relationship with you:

Address:
Tel/Fax:

E-mail:I understand that withholding pertinent information requested in this application form or giving false information will
make me ineligible for admission or liable for dismissal.

Signature

Date submitted

Postal address for submitting the application documents:
English Engineering Education program (e3)International Affairs Office of Engineering (A1-58)
Graduate School of Engineering
Hokkaido University
Kita 13 Nishi 8, Kita-ku
Sapporo 060-8628, Japan
TEL:81-11-706-8089

FOR OFFICIAL USE
PartI

To be filled out by professor who accepts the applicant

I would like to accept this applicant as a master/doctoral student under my supervision. During the applicant’s
enrolment I will act as his/her contact person in Japan in case he/she is involved in some incidents and accidents.
Name:
Laboratory:

Signature:

Date:

Part II To be signed by Chairman of the Division the above professor belongs to after the applicant is
accepted by the professor above.
I agree to allow this applicant to be considered for enrolment in the Division.

Name:
Division:
Signature:Date: