Accepted by postal only

Month/Date/Year

Request Form for Disclosure of Admission Information
Head of University of Tsukuba（Applicant）
Address

postal code：－NameDate of BirthE-mailphone number（）

I request disclosure of Entrance Examination information.
記
Name of the graduate
school/degree program
you have applied forDegree Programs in
Master’s Program in

Examinee’sID Number

Month (Category)Contents of Disclosure

Tsukuba Campus□ July Selection Process（Special Selection Process for Recommended
Applicants、General Selection Process、Special Selection Process forWorking Individuals）□ August Selection Process（General Selection Process、SpecialSelection Process for Working Individuals）□ October Selection Process（General Selection Process、SpecialSelection Process for Working Individuals）□ January to February Selection Process（General Selection Process、Special Selection Process for Working Individuals）

Total Score of the Candidate
Who Failed the Examination

Tokyo Campus□ July to November Selection Process（Special Selection Process for
Recommended Applicants、General Selection Process）、February
Selection Process（General Selection Process）※ Please check the box.
（Note）1. In principle, we will not respond to requests other than those made by the applicant
himself/herself.
2. The information to be disclosed will be the results of unsuccessful applicants for entrance
examinations conducted in the previous year; information from other years will not be disclosed.
3. This request will be accepted for the month of May 1-31.
4. Requests will be accepted by postal only.
Please fill out this request form and send it by mail to the Billing Office with a Reply Envelope(with a 460 yen stamp attached and your name, address, and postal code written on the front)
and identification documents (a copy of your university's examination voucher or ID card).
However, if you are an Overseas Resident, Please Inquire by E-mail to the Billing Office.
[Do not fill in the following]

開示年月日

年月日

担当者

年月日

本人確認

受付番号

Example

Accepted by postal only

Please fill in all the information enclosed in the red box.

May,1,2025

Request Form for Disclosure of Admission Information
Head of University of Tsukuba（Applicant）
Address

postal code： 305－8577
Corpo-Tsukuba 301, 1-1-1, Tennodai, Tsukuba, Ibaraki

Name

Taro Tsukuba

Date of BirthApril, 10, 2002

E-mailxxxxxx-zzzzzz@tsukuba.jp

phone number

070 （ 1234 ） 5678

I request disclosure of Entrance Examination information.
記
Name of the graduate
school/degree program
you have applied forDegree Programs in Systems and Information
Engineering
Master’s Program in Policy and PlanningSciences

Examinee’s
ID NumberMonth (Category)

11ZZ10001

Contents of Disclosure

Tsukuba Campus□ July Selection Process（Special Selection Process for Recommended
Applicants、General Selection Process、Special Selection Process for
Working Individuals）☑ August Selection Process（General Selection Process、Special
Selection Process for Working Individuals）□ October Selection Process（General Selection Process、Special
Selection Process for Working Individuals）□ January to February Selection Process（General Selection Process、Special Selection Process for Working Individuals）

Total Score of the Candidate
Who Failed the Examination

Tokyo Campus□ July to November Selection Process（Special Selection Process for
Recommended Applicants、General Selection Process）、FebruarySelection Process（General Selection Process）※ Please check the box.
（Note）1. In principle, we will not respond to requests other than those made by the applicant
himself/herself.
2. The information to be disclosed will be the results of unsuccessful applicants for entrance
examinations conducted in the previous year; information from other years will not be disclosed.
3. This request will be accepted for the month of May 1-31.
4. Requests will be accepted by postal only.
Please fill out this request form and send it by mail to the Billing Office with a Reply Envelope(with a 460 yen stamp attached and your name, address, and postal code written on the front)
and identification documents (a copy of your university's examination voucher or ID card).
However, if you are an Overseas Resident, Please Inquire by E-mail to the Billing Office.
[Do not fill in the following]

開示年月日

年月日

担当者

年月日

本人確認受付番号