Entrance in April, 2021 and in October, 2020
Entrance Examination of Mie University Graduate School ofEngineering Doctoral Course

Application Documents

Mie University Graduate School of Engineering※Checklist
PreferredDivision

Name

Check necessary documents for each examination and put ○ marks in check box. Submit all
the necessary documents within the application period.

NecessaryforDocuments

Notes

aApplication Formfor Admission【Form provided by the Graduate School ofEngineering】b

Picture Card and Examination
Admission
Card【Form provided by the Graduate School ofEngineering】【Form provided by the Graduate School ofEngineering】Paste the Payment Certificate on thedesignated space of the application form.
Those who continue to study in theGraduate School after the completion ofMaster's course in Mie University do nothave to pay.
Foreign students sponsored by Japanese
government (Ministry of Education) do nothave to pay.
【Form provided by the Graduate School ofEngineering】
Those who are in or have completed theGraduate School of Engineering at Mie
University do not have to submit.

cApplication

FeedCurriculum

VitaeeCertificate of Degree (orNear Completion of Degree)

fAcademic
TranscriptofUndergraduate
CoursegAcademic
Master'shAbstract of Master's Thesis【Form provided by the Graduate School ofEngineering】

iResearchPlan【Form provided by the Graduate School ofEngineering】

j

Record of Academic Attainment【Form provided by the Graduate School ofEngineering】

TranscriptAll
Examinations

CheckofCourseApplicant onDocument to certify theQualification
k completion of screening⑥corresponding to Qualification ⑥l

Official Score Certificate ofTOEIC
Testm

Consentnoof

Examination

Documents
tocertify
nationality and status ofresidence
Document
tocertify
thestatusof
Governmentsponsored foreign students

Applicant ofGeneral
Selection

Applicant ofContinuing
Education
ForeignStudentForeignStudent

Only those who wish to be evaluated by thescore of TOEIC Test shall submit thisdocument.
【Form provided by the Graduate School ofEngineering】
Those who belong to Mie University do nothave to submit.
Those who belong to Mie University do nothave to submit.

Notes 1. If there should be any missing pages or breaks in the form provided by the Graduate Schoolof Engineering, please contact the Student Affairs Office in the Graduate School of Engineering at
Mie University.
Notes 2. ※Leave blank.

Circle the month of entrance and the classification to apply.

Entrance in April, 2021 and in October, 2020
Mie University Graduate School of EngineeringYear and Month ofEntrance

Doctoral Course

Classification

Examinee Number

General Selection

April, 2021Continuing
Education Student

Application Form

October, 2020※

Foreign Student

Name

NameA.D.

Date of Birth
〒YY

MMDD

Sex

Male/Female－Prefecture

Name of Apartment
Current
Address andContact
Home Phone Number
NumberCell Phone Number

Attach the Payment Certificate
here.
（）

－（）

－@mail adress
Preferred Division
Preferred
Division andLaboratory

Attach the Payment
Certificate.

Doctoral Course

Division

Preferred Laboratory
Preferred Education
and Research FieldPreferred Main
Advising Teacher
Name of the Graduating University and the Graduate School

Graduating School
Qualifications forApplication

Name of the Division or Course

Month and Year ofGraduation
Date Certified theEntrance Qualification

A.D.

Year
Year

MonthMonth

Expected to Graduate/ Graduated
Date

Certified the Entrance Qualification

Filled only by applicant of Special Selection for Continuing Education Student
Current Employer

Employer
Employment History

Period of
Employment

Year

Month～

Present

Period of
Employment

Year

Month～Year

Month

Period of
Employment

Year

Month～Year

Month

Period of
Employment

Year

Month～YearMonth

Filled only by applicant of Special Selection for Foreign Student
Nationalityand Statusof Residence

Foreign Student Sponsored by Japanese
Government (Ministry of Education)

NationalityClassification

Status of Residence

Privately Financed Foreign Student (ForeignGovernment Dispatch Student Included)

Notes 1. Please refer to the "Guidelines to fill in the Application Form" on the back.
2. ※Leave blank.

Guidelines to Fill in the Application Form
Please be sure to refer to the following "1. Notes" and "2. How to Fill In.".
1. Notes
A. Please use a black ballpoint pen to fill in. Do not use a pencil or a mechanical pencil.
B. In case of a mistake, cross out with a double line. Do not use a correction tape or a correction fluid.
C. ※Leave blank.
D. If you have any inquiry, please contact the Student Affairs Office at the Graduate School of Engineering,
Mie University.
2. How to Fill In.
① Year and Month of Entrance and Classification
A. Circle the Year and Month of Entrance and Classification that you will apply for.
② NameA. If you are an applicant for the Special Selection for Foreign Students, fill in your name with alphabet.
B. If you are an applicant for the Special Selection for Foreign Students, you may fill in your year of birthwith A.D.
C. Circle your sex, male or female.
③ Current Address and Contact Number
A. Fill in your address and contact numbers that we can surely send the notification and documents or cancontact you.
B. If there should be any changes after the application, inform the Student Affiars Office of the Graduate
School immediately.
④ Preferred Division and Laboratory
A. Choose one division from the Division of Materials Science or the Division of Systems Engineering.
B. To fill in Preferred Laboratory, Preferred Education and Research Field, and Preferred Main Advising
Teacher, please refer to "Outline of Graduate School of Engineering (Doctoral Course), Mie University"in"Application Guidelines for Mie University Graduate School of Engineering".
⑤ Qualifications for Application
A. Please write the name of your graduating university and graduate school in the upper line, and the name ofthe division or course in the lower line.
B. If you are a foreign student, you may use the dominical year to fill in the year of graduation.
C. If you are certified the entrance qualification, please fill in the date of certification notified fromthe university.
⑥ Employer (Only for applicant of Special Selection for Continuing Education Student)
A. If you are currently employed, please fill in the name of current employer and period of employment.
B. If you are not employed, please fill in your employment history and period of employment.
⑦ Nationality and Status of Residence(Only for applicant of Special Selection for Foreign Student)
A. Please fill in the Status of Residence at the point of application.
B. Please circle your appropriate classification as a foreign student.

＜Contact Address＞
Student Affairs Office,Graduate School of Engineering, Mie University
1577 Kurimamachiyacho, Tsu, Mie514-8577
TEL 059-231-9499 / FAX 059-231-9471
e-mail eng-admission@eng.mie-u.ac.jp

Entrance in April, 2021 and in October, 2020 Entrance in April, 2021 and in October, 2020

Mie University Graduate School ofEngineering, Doctoral Course

Mie University Graduate School ofEngineering, Doctoral Course

Picture Card

Examination Admission Card

General Selection

Classifica
tion

Special Selection forContinuing Education
Student
Special Selection for
Foreign Student

PreferredDivision

Division※Examinee
NumberGeneral Selection

Classification

Special Selection forContinuing Education
Student
Special Selection for
Foreign Student

PreferredDivision

Division※Examinee
NumberName

フリガナ
Name

Attach photo.
Attach photo.

1. See anothr paper for the date and place ofexamination.
2. Be sure to bring this Examination Admission
Card to the examination.
3. Keep this Examination Admission Card until
the enrollment procedure.

Note. 1. Circle the classification to apply.
2. ※Leave blank.

Note. 1. Circle the classification to apply.
2. ※Leave blank.

Circle the classificaton to apply.

Entrance in April, 2021 and in October, 2020
Mie University Graduate School of Engineering

Classification

Doctoral CourseYear

Educational
Background(High Schoolor Higher)

Date of Birth
MonthDate・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・・※

Foreign Student

Name
Item

General Selection
Continuing
Education Student

Curriculum Vitae

Examinee Number

Showa/Heisei(or A.D.)

Content

Employment
History

Reward andPunishment

I hereby declare that the information above is true and correct.
YearMonthNameNote.

※Leave blank.

DateStampYear

MonthDateCircle the classification to apply.

Entrance in April, 2021 and in October, 2020
Mie University Graduate School of Engineering

Classification

Doctoral CourseAbstract of Master's Thesis
NameGeneral
Selection
Continuing
Education
Student
ForeignStudent

Examinee Number※

Preferred
Division

Division

Preferred
Laboratory

Laboratory

Title of Master'sThesis

Note. 1. Abstract should be within 1,000 letters (500 words in English).
If you use a word-processing software, you may directly print on this form or print out on A4 paper.
2. Those who apply with application qualification ⑥ shall write their current research theme in "Title ofMaster's Thesis".
3. ※Leave blank.

Circle the classification to apply.

Entrance in April, 2021 and in October, 20100
Mie University Graduate School of Engineering

Research Plan
NameClassification

Doctoral Course

Esaminee NumberGeneral Selection
Continuing
Education Student※Foreign Student

PreferredDivision

Division

Preferred
Laboratory

Laboratory

Research Theme・Field＜Overview of Research Plan＞

Note. 1. Research Plan should be within 1,200 letters (600 words in English). Please describe succinctly andspecifically. If you use a word-processing software, you may directly print on this form or print out
on A4 paper.
2. ※Leave blank.

Circle the classification to apply.

Entrance in April, 2021 and in October, 2020
Mie University Graduate School of Engineering

ClassificationDoctoral Course

Record of Academic Attainment
Name

Examinee Number

General Selection
Continuing
Education Student※

Foreign Student

PreferredDivision

Division

Preferred Laboratory

Laboratory

Title of Master's Thesis(or Graduation Thesis)

Employer and Period of Employment

Year

Month～

Year

Month

Year

Month～

Year

Month

Year

Month～

Year

Month

Year

Month～

Year

Month

Main Work Contents

職歴

Please write down the details of past work experience related to research plan. If you have published any papers,
please provide the title, co-author(s), journal name, volume number, issue number, year, and page number. (Within1,000 letters in Japanese, or 500 words in English)

Note. ※Leave blank.

Classification

Continuing
Education Student

Examinee Number※Consent of Examination
YearMonthDate

To the Dean of the Graduate School of Engineering, Mie University

Position
Title
Name

I hereby give my consent for applicant below to take the entrance examination of Mie
University Graduate School of Engineering, Doctoral Course.

NoteFurigana
Name
Position
Position andothers

Title
Periodof
Employment

YearMonth～Present