2024 Graduate School of Sciences and Technology for Innovation, Tokushima University
Division of Regional Development
Division of Clinical Psychology“ Master Course ”

Admission Guide for Research Students
１ Summary of the ProgramThis program is for students who seek to conduct research for specific themes under the guidance ofacademic advisors. There is no credit offered in this program.
２ Requirements
Master Course: Applicants are required to have master’s degree or confirmed as having achieved suitable
academic standards equivalent.

３ Application Procedure① Applicants living in Japan should bring all documents including the application form to the following place.
② Applicants who live overseas and are not able to bring documents may apply through the Internet.
Applicants can download application forms on the website below. And send the application form to theStudents Affairs Section of the Faculty of Integrated Arts and Sciences by e-mail and pay the examination fee
by a credit card or the China Union Pay. Documents listed in “(3) Application documents” below should besent to the following address by post by the deadline. After all necessary documents arrive and are considered
complete; the application procedure will be completed. Please be sure to understand that the procedure is notcompleted when the student simply sends an application form through the Internet.
Faculty of Integrated Arts and Sciences, Tokushima University: Information of Entrance Examination
http://www.tokushima-u.ac.jp/ias/admission/(1) Deadline for application
First semester
International Applicant without visa: Monday, November 13, 2023 ～ Friday, November 17, 2023
Other applicants: Monday, January 15, 2024 ～ Friday, January 19, 2024
Second Semester
International Applicants without visa: Monday, May 13, 2024 ～ Friday, May 17, 2024
Other applicants: Monday, August 19, 2024 ～ Friday, August 23, 2024
(2) Place to submit
Student Affairs Section of Faculty of Integrated Arts and Sciences, Tokushima University
1-1 Minamijosanjima-cho, Tokushima 770-8502(Refer to ★ ”7 Layout drawing”)
Telephone: 088-656-7108
skgakumk@tokushima-u.ac.jp(3) Application documents

Enrollment Application①Fill in the application and attach a picture (photographed within 3 months; half of
the upper-body, without a cap, the front and sized 4cm×3cm).
②Must receive official stamp of approval from a supervisor.
③Applicants who apply on Internet should submit this application, as well.

Letter of acceptance

Submitted by applicants who are employed.

Medical Certificate

Applicants should have a medical checkup within 3 months of applying and should
submit an official Medical Certificate that is written and sealed by a doctor.

Warranty Certificate①Should be handwritten by the applicant.
②Unnecessary for international applicants.

Promissory Letter

Should be handwritten by the applicant.

Graduation Certificate or Applicants should submit a graduation certificate or original copy of diploma of theOriginal copy of Diploma last school or institution the applicant graduated from or completed.
Admission certificate
Application

Submitted by applicants who need an admission certificate for visa acquisition.

Pre-confirmation Sheet(Only internationalstudents)

Written by the supervisor of the applicant.

※1
Examination Fee

9,800 yen
Pay the examination fee at the Josanjima Accounting Office after applicant hasreceived the confirmation at the Student Affairs Section of the Faculty of Integrated
Arts and Sciences.

OthersApplicants should submit any document proving qualification to enroll.

Note1) We are not able to accept incomplete documents.
2) Any certificates written in languages other than Japanese should have a Japanese translation attached.
3) ※1 “Examination Fee” is available for paying on the Internet. Please refer to the Tokushima University Student
Portal for details.
https://www.tokushima-u.ac.jp/isc/admission/

４ Month of Entrance
Enrollment is generally in April and October.
５ Entrance Procedure(1) Expense (as of June 1st,2023)① Entrance Fee
84,600yen② Tuition Fee (monthly)
29,700yen③ Insurance Fee of student education study disaster and accidents (for one year)

1,000 yen

(2) Payment period① Entrance Fee: After admission is permit by the end of March for Semester 1
by the end of September for Semester 2② Tuition Fee: by end of April for Semester 1
by end of October for Semester 2③ Insurance Fee of student education study disaster and accidents: by the time of entrance(3) Place of payment
Josanjima Accounting Office, Tokushima University
2-1 Minamijosanjima-cho, Tokushima 770-8506(Refer to ● “7 Layout drawing”)

(4) Payment Method
Generally applicants should pay in cash at the counter６ NoteExamination Fee as noted above is listed as of June 1st, 2023and is subjected to change.
７ Layout drawing★Student Affairs Section, Faculty of Integrated Arts and Sciences●Josanjima Accounting Office

1. Building No.1, Faculty of Integrated Arts and Sciences
2. Building No.2(West Building), Faculty of Integrated Arts and Sciences
3. Regional Cooperation Plaza
4. Building No.2(East Building), Faculty of Integrated Arts and Sciences
5. Building No.3, Faculty of Integrated Arts and Sciences
6. Liberal Arts and Sciences Building No.4
7. Liberal Arts and Sciences Building No.5 & Health Service, Counseling and Accessibility Center
8. Liberal Arts and Sciences Building No.6 & Center for Community Engagement and Lifelong Learning
9. Student Hall
10. Regional and international Exchange Hall（Glocal Communication Hall） & Center for Community
Engagement and Lifelong Learning
11. Cafeteria
12. Gymnasium
13. Music Building
14. Library
15. Building for Department of Civil and Environmental Engineering & Research Center for Management ofDisaster and Environment
16. Laboratories for Department of Civil and Environmental Engineering
17. Building for Department of Electrical and Electronic Engineering
18. The Common Lecture Building
19. Innovation Plaza
20. Building for Department of Mechanical Engineering

21. Building for Department of Chemical Science and Technology and Biological Science and Technology
22. Research and Experimentation Laboratories
23. Building for Department of Optical Science and Technology
24. Center for Administration of Information Technology & Building for Graduate School
25. Intelligent Information South Building
26. Intelligent Information North Building
27. Practice Building for Department of Mechanical Engineering
28. Memorial Hall of Alumni(Engineering)
29. Cafeteria
30. Cafeteria
31. Institute of Post-LED Photonics
32. Building Incubation Facilities & Center for Research Administration & Collaboration & Industry-University
R&D Startup Leading Institute
33. Venture Business Development Laboratory
34. Cafe Building
35. Extracurricular Activities Building（別紙第１の４号様式）(Annex Form 1-4)

令和年度徳島大学研究生入学願書((year) Tokushima University Research Student Enrollment Application)
令和(Date:年月日)

徳 島 大 学 長殿
(To the President of Tokushima University)
私は貴学の研究生として入学したいので，許可くださるようお願いします。
(I hereby apply to enroll at Tokushima University as a Research Student.)
写真貼付

ふ り が な( Furigana )

氏

男・女

名

(Male / Female)( N a m e )年

月日生(Date of birth)

最 終 学 歴(Highest level ofeducation)

勤務

年(Date:

月（卒業・卒業見込・修了・修了見込）) ( Graduated / Expect to graduate / Completed a course/ Expect to complete a course )先(Place of work)

現住所(Current address)(Attach photo here)（正面・脱帽）(Full face with nohat)

縦 4cm×横 3cm(Vertical 4 cm ×horizontal 3cm)

ＴＥＬ（）

－

ＴＥＬ（）

－

〒
(Postcode)

志望学部，
研
究科又はセンター(Faculty, schoolor center where
you want tos t u d y )在学希望期間(Desired periodo f s t u d y )令和年(From (date):月日～ 令和to年

月日)

研 究 題 目( R e s e a r c hs u b j e c t )承 認 印
指 導 教 員(A p p r o v a l)

( A d v i s e r )備考( R e m ar k s )※１ 願書は志願者本人の自筆で記入してください。(*1 The applicant should fill in the applicationthemselves.)※２「承認印」欄は，事前に研究指導教員に確認の上，押印を依頼してください。
(*2 Ask the adviser who has agreed to accept you for their signature in the Approval field.)※３ 提出された個人情報は，入学の選考，学籍管理に関する業務（追跡調査を含む。
）のみに使用します。
(*3 Personal information will only be used for selection and registration purposes (including tracking studies).)（別紙第１の４号様式）(Annex Form 1-4)

履

歴事学年(Date:月日)

年(Date:月日)

年
月(Date:日

年月(Date:日年
月(Date:日年
月(Date:日年
月(Date:日年
月(Date:日歴 (Academic background)))))))
職賞

項 (Personal background)

年月(Date:日年
月(Date:日年
月(Date:日年
月(Date:日年
月(Date:日年
月(Date:日歴 (Professional background)))))))罰( Awards and penalties )※１ 学歴は高等学校卒業から記入してください。
ただし，外国人出願者は小学校から記入し，大学等で研究生として在学歴がある場合は，その期間も記入してください。
(*1 Fill in your academic background starting with the name of your high school.
However, foreign applicants should start with the name of their elementary school and add the period for any
time spent as a research student at university.)※２ 履歴に虚偽の事項を記入したことが判明した場合は，入学許可を取り消すことがあります。
(*2 If any falsehoods are discovered in the information provided, your admission may be revoked.)（別紙第２号様式）(Annex Form 2）
令和年(Date:月日)

徳 島 大 学 長殿
(To the President of Tokushima University)

所属長(Supervisor)
氏 名(Name)

印(Seal or Signature)

承諾書(Letter of acceptance)

下記の者が貴学にとして入学することを承諾します。

(I consent to the person named below to attend Tokushima University as a)記(Details)
氏
名(Name)所属(Affiliation)
在学期間
令和(From (date):年

月日 ～ 令和to年月日)

（別紙第３号様式）(Annex Form 3)

令和

年度徳島大学入学志願者健康診断書((year) Tokushima University Applicant Medical Certificate)(科目等履修生・研究生)(Non-degree student / research student)
ふりがな( Furigana )氏

男(Male)名女(Female)(Name)

生年月日

年(Date of Birth)

月日 生(Date of birth)

現 住 所(Current address)
TEL （）－胸部健その他の疾病(Chest)及び異常康間接(Indirect)の状(Otherdiseases

直接or(Direct)Abnormalities)

撮影年月日
況(Date:（(State)

年月(Date:日）)(MedicalFindings)

ofhealth)

医 師 所 見所見
(Findings)

診断の結果上記のとおり相違ないことを証明する。
(I hereby certify that the above findings are correct.)
令和

年月(Date:日)

住所(所在地) (Address)
医療機関名 (Name of medical institution)
医師の氏名 (Name of doctor)

TEL （）

印(Seal or Signature)（別紙第５の２号様式）(Annex Form 5-2)

誓約書

(Promissory letter)

徳 島 大 学 長殿

(To the President of Tokushima University)

私 は 貴 学 に 入 学 の う え は ，大 学 院 学 則 及 び 諸 規 則 を 守 り ，そ の 構 成 員 と し て の 責 務 を 履 行
す る こ と を 誓 い ま す 。
(On enrolling with Tokushima University , I hereby swear to abide by the regulations of theuniversity and act responsibly as a member of the university.)

令和(Date:年月日)

所属(Affiliation)
氏

名(Name)

入学許可証明書交付願
Admission certificate application
令和年月(Date:徳島大学創成科学研究科長日)殿(To the Dean, Graduate School of Sciences and Technology for Innovation,
Tokushima University)

下記のとおり証明書交付をお願いします。
(I hereby apply for the certificate as below.)記（１）申請者氏名（自署）Name of Applicant (signature)フリガナ（２）入学希望者の氏名

Name of Applicant (with furigana)（３）入学希望者の生年月日・性別
Applicant’s date of birth ・gender
年月日(year)(month)(day)・(gender)（４）在籍区分（○で囲む）
Section of enrollment (make a mark)
学部学生 ・ 大学院生 ・ 研究生 ・ 特別聴講学生 ・科目等履修生

Undergraduate ・Graduate ・ Research ・ Exchange ・ Special Auditing（５）発行依頼理由
Reason for applying（６）発行部数
Number of issue部