様式/Form GS 1/3

立命館大学大学院＊印記載のところは記入不要
Areas with an * are for university use.

入学試験志願票

RITSUMEIKAN UNIVERSITY GRADUATE SCHOOL APPLICATION SHEET
2019

提出日
Filing Date

年/Year

受験番号
Application Number

写真貼付欄

志願受付番号
Registration Number*

入学時期
Semester of Enrollment

Fall Semester (September)

日/Date3cm×2.4cm のカラー写真を貼付してください。

*

入学年度
Year of Enrollment
入試方式名称
Admission Method

月/Month2019

ID Photo
Attach an ID
photo here
(3cm×2.4cm)

JICA Republic of the Union of Myanmar Long-term Training Course on Administrative Capacity Development

学生証番号(本学出身者・在籍者のみ)Student ID Number (Current/former
Ritsumeikan University students only)

性別
Sex

生年月日
Date of Birth

年/Year月/Month

フリガナ/Name in Katakana*Not required if you cannot speak/type Japanese.

氏名/Your Nameas spelled on yourpassport

姓/Last Name

名/Given Name

国籍/Nationality

日本国
Japan

✔ 日本以外Other

取得(予定)在留資格 *外国籍の方のみ(Scheduled) Residence Status

留学
Studentその他
Other

ミドル/Middle Name

出願研究科
Intended Graduate School課程
Intended Degree Level
出願専攻
Intended Major

現住所Your Current Address〒Postal Code:

自宅電話番号
Home Telephone Number
携帯電話番号
Mobile Telephone Number
E-mailスカイプユーザー名
Skype User Name

*Please make an account if you do not already have one and list the user name here. *To be used for interviews when necessary.

保証人氏名
Guarantor's Name

続柄
Relationship with Applicant*Guarantor may be someone
from your home country

保証人住所
Guarantor's Address
保証人電話番号Guarantor's Phone Number

自由記述欄
Other Notes(Ex: Another Address)〒Postal Code:

日/Date様式/Form GS 2/3＊印は記入不要 / Areas with an * are for university use.

①

大学学歴/ University (Undergraduate Level)▼大学卒業(卒業見込)の場合、出身大学を記入してください。
If you have graduated (or are scheduled to graduate) university, please enter the name of that university.
学歴区分/Academic Standing*

終了区分/Graduation Status

卒業

卒業見込

その他

Graduated

Expected to graduate

Other

出身大学名/University

学部学科名/College・Department

学位名/Degree
大学卒業（見込）年月/(Estimated) Graduation Date②

大学院学歴/年/Year

月/Month日/Date

Graduate School▼大学院修了(修了見込)の場合、出身大学院を記入してください。
If you have completed (or are scheduled to complete) graduate school, please enter the name of that graduate school.
学歴区分/Academic Standing*

終了区分/Graduation Status

卒業

卒業見込

その他

Graduated

Expected to graduate

Other

出身大学院名/Graduate School
研究科専攻課程名/
Department・Major・Course
学位名/Degree
大学院修了（見込）年月/(Estimated) Graduation Date③

その他学歴/年/Year

月/Month日/Date

Other Schools Attended▼大学、大学院の学歴が複数ある場合、専門学校等を卒業している場合など、以下の項目に記入してください。
If you have attended more than one university/graduate school/professional school, etc… please enter below.
学歴区分/Academic Standing*

修了区分/Graduation Status
出身大学/大学院名Name of University/ Graduate School/
Vocational or Professional School, etc…
研究科専攻課程名
Department・Major・Course
学位名/Degree
大学/大学院修了（見込）年月(Estimated) Graduation Date

年/Year月/Month日/Date様式/Form GS 3/3■留学生情報/ International Student Information

氏名Name (Alphabet)
国籍Nationality
在留資格/ Residence Statusin Japan (if any)なし
None✔ 留学

If you are currently in Japan, please enter yourcurrent Residence Status (otherwise, check"none", and leave the Expiry Date below blank)

その他:
Other:

Student

在留期間満了日/ Residence
Status Expiry Date
留学費用区分
Financial Category

年/Year月/Month

国費(文部科学省)
Japanese Gov. Scholarship (MEXT)

来日（予定）日(Scheduled) Date of Arrival

日/DatePrivately Financed or✔ 私費
Other Non-MEXT Scholarship

2019/ 9
年/Year月/Month

■国費留学生実績情報 / Japanese Government Scholarship History
過去の国費留学生実績なし
あり
Have you received Japanese✔
If "Yes," select scholarship type
Government (MEXT)No
Yes
Scholarship in the past「あり」の場合以下を入力/ If yes, please answer the following questions.

留学生期間：開始
Study Abroad Period : FROM

年/Year月/Month日/Date

年/Year月/Month日/Date

留学生期間：終了
Study Abroad Period : TO
受入大学
University

署名
Signature

日付
Date