(A)Application no.

Checklist for Internal, Private Organizations, andLocal Government Scholarships
Student ID
numberGraduate School of(Master’s / Doctoral) program
Major
Year level(2-year / 3-year) courseFurigana
Full name[Caution] If your individual number or “My Number” for the Social Security and Tax Number System is included in documents, please be sure to submit after
blotting out all instances with a personal information protection stamp (the use of black ink is not permitted.)

Please confirm all details below and tick the “Self-check” column for all items that will be submitted.
The submission documents should be arranged in order from 1 to 12 as stated below and submitted together with this checklist.
Reference（Shogakukin Annnai;Japaneseversion）

Items to be confirmed

Selfcheck

Check byuniversity

Application slip

p. 26 ①□ Is the name of the scholarship and scholarshipprovider correct?
□ If you are applying for donor designated scholarships
recruiting in the Spring Semester, have you checked tomake sure that you are not applying to more than 3, themaximum number you are permitted to apply to?

□□Checklist (this sheet)

p. 26 ②□□OrderDocuments❶

❷❸

❹

❺

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AY 2024 Graduate School Application Form

p. 26 ③□ Have you entered all of the required items?
□ Have you printed out single-sided on A4 inmonochrome?

□□

Applicant Information Sheet(Graduate)

p. 26 ④

□ Have you entered all of the required items?
□ Have you printed out single-sided on A4 inmonochrome?

□□

Latest certificate of annual income

p. 30
❶-1

□ Is this the latest certificate issued by the local
municipal office?
□ Have you prepared certificates for both of yourparents? (Submission required even if they have noincome.)□ Does the certificate state the number of people
including your spouse and dependents and theamounts, breakdowns, and categories of incomes andearnings as well as the categories of any deductions?
Have you made sure that incomes and amounts havenot been hidden with asterisks, etc.?

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p. 31 ❷
–p. 33 ⓱□ Have you prepared certificates for both of yourparents?
□ Have you carefully checked pp. 26–31 to ensure thatno documents are missing or incomplete?
[Important] ・Please prepare the documents in A4 size.
□ Have you made sure that your Individual Number“My Number” is not included on the documents youwill submit? If it is, please only submit these after
blotting out all instances with a personal information
protection stamp (the use of black ink is notpermitted).
□Depending on the amount of income (2.1 million yen
or less for a two-parent household), submission of a
“Financial Supporter Report” is required.

□□□ Have you prepared a Financial Supporter Report(document ) if the circumstances detailed on p.32 ⓬apply?

□□

・For both parents [in cases where bothparents are absent, the person who
supports the household finances in theirplace]・For the applicant and his/her spouse if
applying as a financially independent
personRequired documents attesting tohousehold circumstances and income
・For both parents [in cases where bothparents are absent, the person who
supports the household finances in theirplace]・For the applicant and his/her spouse if
applying as a financially independent
person[Applicable persons only]❼Documents required for special
deductions due to income andhousehold circumstances(Tick the below boxes for the special
deductions that apply)□ Single-parent household□ Disability(The below differ depending on the content ofdeductions)□ Have you prepared the latest certificate of annual
income and the required documents concerning
household circumstances and earnings if you are amember of a single-parent household with no working
siblings but grandparents aged 60 years or older are
included in the living expenses, or if your parents areabsent and older siblings (not at school) who are notRemarksmarried are included in the living expenses? p. 33 ⓰□ Have you prepared copies of the “National Pensionand Welfare Insurance Pension Certificate,” “Pension
Payment Notification,” etc., if you are a member of asingle-parent household through bereavement andare receiving a survivor’s pension? p. 33 ⓰□ Have you prepared a copy of the “Child Support
Notification Certificate” if you are a member of asingle-parent household and are receiving child careallowance? p. 33 ⓰□ Have you prepared a copy of the physical disability
certificate and documents certifying the nursing carelevel, etc., if a member of the household is disabled?
p. 33 ⓱Documents relating to academicgrades

p. 26 ⑤

□ If a first-year student, have you prepared copy of thegrade report for your previous degree program (onlyfor students who advanced internally at Keio) or yourTranscript of Academic Record, and if a second-year
student or above, copies of your grade reports for yourcurrent and previous degree programs (only forstudents who advanced internally at Keio) or yourTranscripts of Academic Record?
[Important] Please prepare original copies of yourTranscripts of Academic Record.
・Refer to p. 26 ⑤ if applying in the Fall Semester(Spring Semester for September entrants)□□

Copy of the two-page spread of thestudent’s bankbook showing theaccount holder’s name and details(A4 size)

p.26 ⑥□ Has the bank account been opened in your name?
□ Have you made sure that you have not designated abank to which money cannot be transferred? p. 26 ⑥
□ Have you made sure that there are no changes to thebranch name, branch number, or account number?
[Important]・Please do not cut the sheet of the photocopy to thesize of the bankbook.

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Essays, study plans, disaster victim
certificates, etc.
*Only for scholarships specifying asnecessaryp. 27 ⑩□ Have you filled in using a black pen or black ballpointpen?
□ If you are repeating a year or undergoing screening
for advancement and are applying to the “KeioUniversity Degree Completion Scholarship,” have you
downloaded and filled in the “Study plan”?
□ If you are applying to a scholarship for Keio students
who were affected by a large-scale natural disaster,
have you prepared a disaster victim certificate?

□□p. 27 ⑮

□ If the circumstances detailed in p. 27 ⑮ apply,
have you prepared a “Declaration of FinancialIndependence” (document enclosed in booklet)?
□ Have you prepared documents showing that you
are not a dependent of your parents?
□ Have you prepared documents showing that youlive separately from your parents?

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p. 27 ⑯

[Important]・Students of the Graduate School of
Science and Technology and the Graduate School ofMedia and Governance are required to submit their“Research Accomplishments.” p. 27 ⑯・Students from the Graduate School of HealthManagement are required to submit a “Research Plan”
or other documents depending on the scholarship.
・Second-year students or above in the doctoral
program of the Graduate School of Pharmaceutical
Sciences are required to submit a “Research Report” orother documents depending on the scholarship.

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[Applicable persons only]
Documents required if applying as afinancially independent person⓫[Applicable persons only]
Documents required for theapplication by your graduate school⓬*If you apply by post, please inform the scholarship section on your campus that the application has been sent.
Stamp of receipt