Applicant’s Name（Alphabet）:.
Form 1

Submission Instructions and Application Checklist
出願の説明と出願書類チェックリスト

O-NECUS Program 2025-2026
Application Submission to Okayama University
Friday, January 10, 2025
Application Guidelines for O-NECUS program 2025-2026 are now available. Please make sure to complete all
documents as soon as possible.
2025 年度入学の O-NECUS プログラムの募集要項ができました。早めに書類を揃えるようにして下さい。

★Submission Instructions★

1. Read the instruction carefully on the form as you complete your applications. 願書をよく読む。
2. Take a TOEIC, TOEFL, IELTS, or/and JLPT test. 語学能力試験を受ける。
3. Find a department which suite you the most. 自分にあった教育研究分野を見つける。
Department and Research Projects：https://www.mdps.okayama-u.ac.jp/en/about/global-engagement/
教育研究分野案内 https://www.mdps.okayama-u.ac.jp/about/global/

4. Get a permission to take the examination from prospective supervisor in Japan.
希望の指導教員から受験の許可を得る。
5. Prepare all documents in the checklist below.下記にあるチェックリストの書類を全て準備する。
6. Submit your completed documents to the International Office at your university.
大学へ出願書類を提出する。
7. Take Oral Examination (March) 面接を受ける。（3 月）
8. Wait for the result ( April) 合格発表を確認する。（４月）★Application Checklist★

All documents must be written in English or Japanese. Tick ✓ in the boxes for the application documents youare submitting.
すべての出願書類は英語または日本語で記入してください。 提出する書類に✓印を記入してください。

NoTick✓Application Documents 出願書類

[1]

□Submission Instructions and Application Checklist
出願の説明と出願書類チェックリスト[2]□

Application for O-NECUS Program 2025-2026
2025 年度 O-NECUS プログラム入学願書[3]□O-NECUS Program Personal History O-NECUS プログラム履歴書 Form 3[4]□

Certificate of Student Registration issued by your university (Official document)
現在在籍している大学の在籍証明書（大学が発行する公式なもの）[5]□

Letter of Recommendation written by your professor with his/her signed Form 4
在籍大学指導教授の推薦書[6]□Personal Statement of Research Planning Sheet 研究計画書 Form 5[7]□CERTIFICATE OF HEALTH 健康診断書

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□Form 1

Form 2Form 6

Language Proficiency (Copy of Certificate)
語学力を証明する資料（合格通知書のコピー）
E-mail records with prospective supervisor. It must include a statement that theapplicant is permitted to take the examination.
受入希望教員との E-mail 交信録 ※受験可能な旨を記載してあること
Copy of Passport パスポートのコピー
1Form 2

Application for O-NECUS Program 2025-2026
Applicants must complete and submit all required application documents no later than January 10, 2025. If
the applicant misses the deadline or the contents of their response is illegible, their registration will be
revoked or cancelled.
■Applicant’s Name (Print your name as it appears or will appear in your passport)(氏名) Name in Chinese Characters

Photograph(45mm x 30mm)(ローマ字) Name in Roman Block Letter■Marital Status■Date of BirthSingle/Married/

GenderFemaleAgeyyyy / mm / dd

■Current Address, Telephone Number, and E-mail(Current Address)(Telephone Number)(E-mail)■Current Student Status at University in China(Institution)(Division)(Department)

Period of Enrollment

FromTo■Previous Student Status at University in China (Undergraduate)(Institution)(Division)(Department)

Period of Enrollment

FromTo■Intended Supervisor at Okayama University(Department)(Supervisor)■Title of Research at Okayama University(English)■Keywords(English)■Supervisor at University in China(E-mail)2MaleForm 3

O-NECUS Program Personal History
Applicant’s Name (Print your name as it appears or will appear in your passport)(氏名) Name in Chinese Characters(ローマ字) Name in Roman Block LetterName

Year and Month of
Entrance and CompletionFromTo

Duration

Primary Education

AcademicRecord

Lower Secondary
Education
Upper Secondary
Education
Tertiary Education（Undergraduate）
Tertiary Education（Graduate）
FromToName of organization and position

Employment
RecordList your significant publications (published paper, presented paper, report, conferences, etc.). Fill in enoughinfomation such as title, year, journal name, co-authors so that the examinaer could check the work. Write in English.

Language
Proficiency

Japanese
English(e.g.IELTS overall score 5.5）

OthersAfter you are admitted to Okayama University, and you have to leave Japan temporally during O-NECUS
program (from October 1, 2025 to September 30, 2026) due to any unavoidable reasons, such as the
medical exam, please write a scheduled date.
When:Reasons:3Form 4

Letter of Recommendation
Dear Dean,
Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama University
I recommend a student for admission to O-NECUS program 2025 as below. I hereby agree that I willsupervise him/her jointly with supervisors of Okayama University.
Applicant’s Name (Print your name as it appears or will appear in your passport)(氏名) Name in Chinese Characters(ローマ字) Name in Roman Block Letter

Title of Research at your home university(English)Fill in the applicant’s intelligence, ability and personality.

DateName

Signature

Position
Faculty/ Affiliation
E-mailTelephone4Form 5

Personal Statement of Research Planning Sheet
Applicant’s Name (Print your name as it appears or will appear in your passport)(氏名) Name in Chinese Characters(ローマ字) Name in Roman Block Letter

Institution
Supervisor at home university in China
Title of Research at Okayama University(Japanese or English)

Fill in the general information about your research.

5Form 6

健康診断書 CERTIFICATE OF HEALTH*Fill in this form in English or Japanese□ 男 Male□ 女 Female
氏名(FAMILY NAME)(First name)Name

生年月日年月日生（満Date of BirthYearMonthDay歳）
Age

現 住 所
Present Address

既 往 症
Past History

身体長cm

Height重kg

Weight(With Glasses or Contact Lenses)

視力

Eyesight

右 Right（）

左 Left（）

胸部Ｘ線□ 間接 Indirect

Chest X-ray Examination

所見 Impression

聴力

右 Right

Hearing

左 Left□ 直接 Direct

内科理学的所見
Physical or Psychological
Conditions

現在の健康状態
及び疾病異常Present Condition ofHealth and Disease

その他の所見Other Remarks

上記のとおり診断します。

I hereby declare that the above statement is true and correct.

年月日

YearMonthDay

医師氏名 (Physician’s Name in Print)
医療機関名 (Office/Institution)
住所(Address)

電話番号 (Telephone Number)
印
Official Seal and Signature（注）診断事項中，異常がない場合もその旨記入して下さい。
Please fill in this form even if there is no abnormality in the diagnosis.
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