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Student ID No.
Paste yourFY() Application for Admission for
Graduate School of Information Science and Technology, Osaka University
Doctor Course – Special Selection for International Applicants, Admission in Octoberphotograph
4cm x 3cm

Please leave blank in the fields with *.
Signature

Name of preferred supervisor**

Preferred major
NameGenderDay

MonthYear

Legal domicile (Prefecture for Japaneseor nationality for international students)

Date of birth□ Japanese government
scholarship student

Application□ Foreign governmentsponsored student□ Unsponsoredstudents

international(Select the corresponding number from “application qualification” in Application Guideline.)
Last school attended
Date of graduation or expected graduation
Day/ Month

Applicantqualification

For international students

Current address/ YearAddress

zip code

Phone

MobileEmail address

Contact (Note 1)

NameJapan

ContactAddress

zip code

Phone
Name
Home country

ContactAddress

zip code

Phone
ResumeEducational
background(Note 2)
Employment
history(if applicable)

FromtoFromtoFromtoFromtoFromtoFromtoFromtoFromtoI will submit [□at the time of application □on the first examination day].
□I will not submit.

TOEIC score, etc.
For person in employment
Note 1)
2)

I will [□resign□not resign] after admission.

For international students, make sure to enter contact information both in Japan and home country. For other students,
enter contact information in Japan only.
In the educational background field, start entering with high school entrance information. For international students, startentering with primary school entrance information. In addition, make sure to enter information regarding research student
or student of Japanese-language school if applicable.

Academic affairs*Check*Examination Admission Card ( FY)

1. Front upper body, no

Major name
Examinee’s number

Photographhats, single person
taken within the past 3*months
2. 4 cm x 3 cm
3. Paste the same
photograph as the oneused for Photo
Identification Card.

Name

Shooting date:

Graduate School of Information Science and Technology, Osaka University----------------------------------------------------------------------Do not detach. ----------------------------------------------------------------------

Photo Identification Card ( FY)

1. Front upper body, noMajor name
Examinee’s number

Photographhats, single person*

taken within the past 3months
2. 4 cm x 3 cm
3. Paste the same
photograph as the oneused for Photo
Identification Card.

Name

Shooting date:

Graduate School of Information Science and Technology, Osaka University

Please leave blank in the fields with *.

.

Graduate School of Information Science and Technology, Osaka University

Research Plan
Reception No.

*

Examinee’s No.

*

Preferred major
Name

Name of preferredsupervisor

Preferred research contents (Enter specifically.)(Note) (1) Please leave blank in the fields with *.
(2) Regarding the preferred course name, please refer to the Information Science and Technology website.
URL: http://www.ist.osaka-u.ac.jp/

Examinee’s No.

Name
Preferred major

Proof of Examination Fee Payment Form

Please paste

Proof of Payment for Examination Fee(Note) Please leave blank in the fields with *.

*Dispatch Slip
Address is where applicant wishes to receive correspondence.
Notification of success and admission procedure will be sent to this address.

Address

Postal Code
Name

Preferred Major
Examinee’s Number *Address

Postal Code
Name

Preferred Major
Examinee’s Number *(Note) Please leave blank in the fields with *.