2025(April ・ October) enrollment2025(April ・ October) enrollment

Graduate School of Sustainable Systems

Graduate School of Sustainable Systems

Science, Komatsu University

Science, Komatsu University(Master's Course)(Master's Course)

Photograph Slip

Examination Voucher
切り

Division

離Division

さな１

Undergraduate Applicant

Admission ２ Employed /Professional
ApplicantCategory
３International Applicant

い１

でくだ
さ

Undergraduate Applicant

Admission ２ Employed/Professional
ApplicantCategory３

いInternational Applicant。

NameName

Do not fill in the ※ mark column.

Do not fill in the ※ mark column.

Attach the
Photo Here（4 cm (length) X 3
cm (width)）
Taken within the last
3 months prior to theapplication
Front, Upper Body,
No CapNo backgroundexaminee's ※examinee's ※serialserialnumbernumber2025 Graduate School of Sustainable Systems Science, Komatsu University
Application Form
Admission Time
（Circle theappropriatecategory）

April・

OctoberClassification

１

Undergraduate Applicant（Circle theappropriate category）

２

Employed/Professional Applicant

３International Applicant

examinee's number※

Major ofinterest

Specialty（Year/Month/Day）
BirthdayName(male〒・female)－Contact－

mobile－－landline－

Email Address
UniversityUndergraduate
Study

Faculty

date

Major

□graduation□expected tograduate

Desired Research
ThemeFirst

SecondChoice

Faculty Advisor that Choice
you expect(Fill in below only for applicants to Division of Production System Science)
Areas and subjects to be selected（Select two of the following areas and one course from each of the two）

Desired Areas andsubjects for theacademic
achievement test

□A Field（□Strength of Materials、□Vibration Engineering）□B Field（□Thermodynamics、□Fluid Mechanics）□C Field（□Algorithm Theory、□Artificial Intelligence）□D Field（□Programming、□Electric circuit）

Note 1: Do not fill in the ※ marked column.
2: Please enter the year, month and date using the Western calendar.
3: In the column for faculty members whom you wish to be supervised after admission, please select and fill in thefaculty members you wish to be supervised by from the list of faculty members in your field of study/teachers listed
in the Application Guidebook.

examinee's(seat)
number※Name
Academic and Professional History（Fill in from high school or secondary
school enrollment）
School's name（Department）

Year and month of admission
and graduation

Admission Date

Secondary/High SchoolAcademic

Graduation Date
Admission Date
university (department)
Graduation Date
Admission Date
Graduation Datebackground

Admission Date
Graduation Date
Admission Date
Graduation Date
Admission Datecertificate of bank transfer payment（space for pasting）

Graduation Date
Admission Date
Graduation Date
Name of Employer

Period of service～

Car
eer

～～～

1.※Do not fill in the "※" column.
2.If you are applying as a person who has completed 16 years of schooling in a foreign country, please enter
your educational background from elementary school so that we can see your 16 years of educational background.
Notes 3.In the "Academic Background" section, please enter any non-degree student statuses such as credited auditors,
on auditing students, research students, etc.
Entry

4.Please enter the year and month using the Western calendar.

Summary of Bachelor's Thesis
Division

Name
Research Topics

Progress, Research Results, etc.

Note: Do not fill in the※ marked column.

【Form 1】

Graduate School of Sustainable Systems Science, KomatsuUniversity
Examinee's※SerialNumberResearch PlanMajormajor subject

furigana (kana)Name
Desired Research Theme

Future Research Plans

Note: Do not fill in the ※ marked column.

【Form 2】

Graduate School of Sustainable Systems Science, Komatsu
University
examinee'snumber※Form for Pre-Screening of Application Qualifications（ Enrollment for the Year of 2025）
Admission Time
（Circle theappropriatecategory）

April・Graduate School of Sustainable Systems
Science, Komatsu University

October

Division

Category

１

Undergraduate Applicant

２

Employed/Professional Applicant

３International Applicant（Circle the appropriate category）

Komatsu University President
I wish to apply for the entrance examination for the Graduate School of Sustainable Systems ScienceProgram) at Komatsu University.

(Master'sHere, I present all the necessary information and documents to prove my qualifications for application.
DateName(Male・Female)(AgeBirthday
CurrentAddress〒)－－Mobile－

Landline－－

Place ofemployment

Present
Occupation

Job Title〒－Location
Phone：Academic Backgroundenrollment.）－－（Please fill in from high school or secondary school

Year of Admission/Graduation
Admission Date
Graduation Date
Admission Date
Graduation Date
Admission Date
Graduation Date
Admission Date
Graduation Date
Admission Date
Graduation Date

Career/Work Experience（Please fill out the form so that we canunderstand your working history.）/W

Period～～～～Activities in Academic Societies and Others

Period～～～～Note 1: If you are an international applicant applying for pre-screening of application qualifications, please
enter your educational background from elementary school.
2 If there is insufficient space, please use more than one copy of this form and write your name on the secondand subsequent copies.

Research Activity and Publication Record
NameGraduate School of Sustainable Systems Science,Komatsu University
１ Undergraduate
General SelectionApplicant
２ Employed/Professional
Socialist Special Selection
ApplicantDivision

Category

３ International
Special Selectionfor Foreign Students
Applicant（Circle the appropriate category）

Academic Papers, Publications, andResearch Presentations・
Title of Graduation Thesis, etc.

Date of Issue,Publication,etc.

Publisher, Journal, etc.
Name of Conference, etc.

Co-author or coauthor
Presenter Name

Note 1: If there is insufficient space, please use multiple copies of this form and enter your name on thesecond and subsequent pages.
2: Please enter volume and pages of publication if available.

Application for Special Exception for Educational Programs underArticle 14 of the Standards for the Establishment of Graduate SchoolsDean, Graduate School of Sustainable Systems Science, Komatsu University

major Graduate School of Sustainable Systems Science, Komatsu(Master's Course)
subject University

Major

examinee's※numberNameI am applying for a special exception to the educational programs based on Article 14 of theStandards for the Establishment of Graduate Schools, as I consider this necessary for mystudies for the reasons stated below.
※2 Long-term enrollment（Reasons for Application）

yes□no□Note1: Do not fill in the※1 marked column.
2:※2For details of the Long-term Enrollment System, please refer to page 19 of these Guidelines. Please be sure
to check the box regardless of whether you wish to apply or not.

examinee's※numberPermission for Entrance Examination
Dean, Graduate School of Sustainable Systems Science, Komatsu University

We hereby give permission for
Sustainable Systems Science,

to apply to the Graduate School ofDivision ((Master's Course)) of youruniversity.
If the applicant enrolls in the Graduate School of Sustainable Systems Science of youruniversity, he/she will be allowed to remain in his/her current position in our company ororganijation.

（Affiliation / Position）（Name）

Note: Do not fill in the ※ marked column.