*Please leave this row blank.

整理番号Osaka School of International Public Policy, Osaka University
Doctoral Course (Enrollment in October 2024)
Application for Qualifying Review
Date of Application (YYYY/MM/DD) ︓//.

To the Dean of Osaka School of International Public Policy, Osaka University
FuriganaName（First Name）（Family Name）

Date of Birth//(YYYY/MM/DD)（Middle name）※☐Male ☐ Female

I hereby submit my preliminary eligibility screening form along with other related documents for application qualification
for admission to the Osaka School of International Public Policy Doctoral Course.

Documents required for an application for qualifying review)(a) Certificate (documentation) of passing the qualifying review
1 copyThe following information issued by the university from which the applicant graduated from, signed by thepresident or equivalent of the university, in accordance with the example below.
[Example]“University Name” hereby recognizes that “Student Name,” a student of the university, has passed the “Title※☐of Examination” and has obtained a master’s degree or equivalent. Please find enclosed the attachments
Application
related to the examination.
materials[Example of Attachments]based on・Criteria
for passing the examination
criterion (6)・Documentation of the relation between passing the examination and the requirements needed tosuccessfully earn a master’s degree at the university.
・Documentation showing the consistency between the person who passed the examination or who holds a
master's degree from another university that has transferred to the university and a doctoral degree‐
granting program at that university.
1 copy(a) Application for qualifying review (this form)
1 copy(b) Curriculum vitae (use the form provided)※☐Application (c) Student registration certificate (*1)
materials (d) Record of research achievements
based on (e) Research topic certificate
criterion (7) (f) Certificate of completion from the last school attended(g) Academic transcripts from the last school attended(h) Recommendation letter from a research supervisor (*6)

1 copy1 copy1 copy1 copy(a) Application for qualifying review (this form)

1 copy1 copy1 copy(b) Curriculum vitae (use the form provided)※☐Application (c) Student registration certificate (*1)
materials (d) Record of research achievements
based on (e) Certificate of completion from the last school attended
criterion (8)(f) Academic transcripts of the last school attended(g) Recommendation letter from a research supervisor (*6)

1 copy1 copy1 copy1 copy1 copy1 copy(*1) Student Registration Certificates are required for current students only.
(*2) All the information, except “整理番号”, must be completed by the applicant.
(*3) Please tick the appropriate box for the items marked with a ※ symbol.
(*4) Please pay special attention to the contact information, as it will be the address for notification of results.
(*5) Please be sure to fill out the name of your desired supervisor, not only your first choice, but also your second choice.
(*6) A recommendation letter from a research supervisor is optional.

Please also complete the back side.

整理番号*Please leave this row blank.

（片面印刷用）Application for Qualifying Review (Back Side)
Nationality （日本国籍の者は都道府県名を記入してください。）

Research Title
Name of yourdesiredsupervisorYour First Choice（〒－Your Second Choice）

Current addressand contact
informationTel－－Mobile phone－－E-mailOther address and （〒information－）(Please be sure to☐ Parent’s home ☐ Workplace ☐ Other (fill out))Tel－(*1) Student Registration Certificates are required for current students only.
(*2) All the information, except “整理番号”, must be completed by the applicant.
(*3) Please tick the appropriate box for the items marked with a ※ symbol.
(*4) Please pay special attention to the contact information, as it will be the address for notification of results.
(*5) Please be sure to fill out the name your desired supervisor, not only your first choice, but also your second choice.
(*6) A recommendation letter from a research supervisor is optional.

－履

歴書

Curriculum Vitae
Osaka School of International Public Policy Doctoral Course

大阪大学大学院 国際公共政策研究科 博 士 後期課 程
教育課程

Name of School学 校 名Standard Period of Study

Country or Region of Location（所在国名）

入学・卒業の年月〔正規の修業年限〕

Enrollment

初等教育

入 学

（小 学 校）

Graduation

Elementary School（国）〔卒 業年〕

中等教育

YYYY

MM年月

YYYYMM年月

入学

年 月（中 学 校）Junior High School
Academic学（国）〔卒業年〕

中等教育年 月入学

年 月

（高等学校）High School（国）〔卒業年〕

高等教育
Background

歴年 月

入学

年 月

（ 大 学 ）
University (Undergraduate Level)（国）〔卒業年〕

年 月

高等教育入学（大 学 院）（Expected） Completion

年 月

修 了 （見 込 み）

University(Graduate Level)（国）〔年〕

年月年 月（国）〔年〕

Total

〔年〕

計入 学
終 了
入 学
終 了

Non-degree
student

研
究生
等

年 月

Job History

職

勤務先・研究機関等の名称/ Name of Employer (Institution)〔在籍年月/Period〕

歴・研Research History
Conferred Degree

取得した学位学 位 の 名 称/Name of Degree

取得年月日/Conferred Date月
月月
月

期 間〔年月〕

自/From至/To年
年月
月

〔年月〕

自至年年月月〔年月〕

自至年
年月
月

〔年月〕

自至年
年月
月

究歴等

年
年
年
年

授 与 機 関 名/Institution（注）初等教育から高等教育まで日本で教育を受けた者は、学校の所在国名欄、初等教育（小学校）欄及び中等教育（中学校）欄を省略してもかまいません。