International University of Health and Welfare,
School of Medicine, 2025

Statement of Purpose

Year/Month/DateK ata k ana

Name(Family name, First name)※ This form must be filled in accurately, clearly and dark with black writing implements by applicants themselves.
※ Please do not write in cursive. Typing is allowed only if in English.
※ Please make sure to fill in the contents within one-page space below.

5thline10thline

15thline

20thline

25thline

International University of Health and Welfare,
Type2

School of Medicine, 2025

Report on Experience of Living AbroadNo.

※All applicants applying for the Special Entrance
Examination for Returnee Students & Students ofInternational School must submit this form.

Year / Month / Date

Katakana【 Notes for filling in the form】

NameJapanese Language Proficiency

1)

Please fill in the period of residence in eachcountry/region from birth to the present (including
the period of residence in Japan) or the period ofenrollment in school or place of employment.

2)

For schools and employers, please clearly indicate thename of the school and the status of expectedgraduation, graduation, transfer, dropout,resignation, or employment.

3)

Please make copies before you write or download
forms from IUHW website as necessary if there
is insufficient space on this form.

4)

Please use the western calendar.

I don't feel anxious at all.
I am somewhat concerned.
It is almost impossible.

Country/Regionof Residence

Period ofResidence

Term

School and place of employment

From/

To/

YrandMo

From/

To/

Yr

andMo

From/

To/

YrandMo

From/

To/

YrandMo

From/

To/

YrandMo

From/

To/

YrandMo

From/

To/

YrandMo

From/

To/

YrandMo

Total period of residence outside Japan

Yr andMo※If the country/region where the school is located is different from the country/region where the applicant was living at the time,please add the country/region where the school or employer is located to the name of the school or place of employment.

In your post-high school history, please explain how you came to live abroad (purpose).

(Example)
Japan

From

2005

/09

To 2012 / 03

6Yrand6 Mo

Not yet entered school

Japan

From

2012 / 04

To 2013 / 07

1Yrand4 Mo○○ Elementary School. TransferTaiwan

From2013/ 08

To 2018 /075Yrand0Mo◇◇ Elementary School. GraduatedUnitedStatesof America

From2018/ 08

To 2021/073Yrand0 Mo△△ Junior High School. GraduatedJapan

From2021/ 08

To 2025 /03

3Yrand8 Mo■■ International School. Expected Graduation

Total period of residence outside Japan

8Yrand0Mo

Type3

International University of Health and Welfare,
School of Medicine, 2025

ResumeNo.
Year /Month /Date【 Notes for filling in the form】

Katakana

１) Please fill in the details as much as possible by theapplicant.
２) Please use a separate frame for each different job
description even working at the same employer.
３) Please make copies before you write or download
forms from IUHW website as necessary if there isinsufficient space on this form.
４) Please use the western calendar.

Name

Employer
Period ofFrom Yr/Mo
Department
Job title andJob description

To Yr/Mo

Assigned
Department

Employer
Period ofFrom Yr/Mo
Department
Job title andJob description

To Yr/Mo

Assigned
Department

Employer
Period ofFrom Yr/Mo
Department
Job title andJob description

To Yr/Mo

Assigned
DepartmentEmployer
Period ofFrom Yr/Mo
Department
Job title andJob description

To Yr/Mo

Assigned
Department

Period ofFrom Yr/Mo
employment

To Yr/Mo
Type ofemployment

Period ofFrom Yr/Mo
employment

To Yr/Mo
Type ofemployment

Period ofFrom Yr/Mo
employment

To Yr/Mo
Type ofemployment

Period ofFrom Yr/Mo
employment
Type ofemployment

To Yr/Mo