Tuition Waiver and Payment Deferral Application
For 2024 and Semester 2
Notes on application◆ You can apply for first semester and second semester at the same time in application for first semester.
・ You can also apply for only first semester or second semester at each time.
・ Applicants who submitted applications for both the first and second semester during the application period for the firstsemester do not have to apply for the second semester again. However, if the information (family, study or household
budget) provided in the application on April 1 has changed by October 1 you must resubmit their applications during
the period for the second semester.
・ If you have been selected as the non-repayable scholarship after April, you must apply for modification in the semester
2.
・ If you take a leave of absence from second semester in spite of you have applied for first and second semester at thesame time in application for first semester, you have to tell us as soon as you can to withdraw the application.
・ In the case that applications for both the first and second half are submitted together, selection results will be
determined for each half separately. Therefore, even if the application for exemption or deferred payment for the firsthalf is approved, the result for the second half will not necessarily be the same. Please confirm the selection result forthe second half as well.
This application is valid only 2024 academic year. Those who will continue to study in the 2025 academic year andthereafter and wish to apply for tuition waiver or deferment should submit a new application for the next academic year.
◆ Do not make tuition payment before it is decided whether you can receive waiver/payment deferral.
Applicants for tuition waiver and payment deferral are given grace to make tuition payment until it is decided whether
you can receive waiver/payment deferral.
◆ Submit necessary documents no later than the deadline.
◆ Note that your waiver or payment deferral will be canceled if any information in your application is found to be untrue.

Tuition waiver program （For regular students only）
The tuition waiver program exempts, based on examination, students who fall under any of the following criteria frompaying certain amount of the tuition on a semester basis. Students who fall under the criteria of this program may also
apply for the tuition payment deferral, which is explained later.

◆ Eligibility criteria

1. The applicant is identified as having difficulty paying tuition due to financial reasons and has good academic standing.
2. The applicant is identified as having extreme difficulty paying tuition because the key income producer of his/herhousehold died or because he/she or the key income producer of his/her household suffered damage caused bywind, flood or other disaster within one year before the tuition payment deadline (in the case of a freshman, within
one year before enrollment). However, this criterion doesn’t apply to cases where the applicant or his/her spouse isfinancially independent or a international student and identified as the key income producer of his/her household,even if his/her parents have died.
3. Students who have been enrolled for years longer than the shortest course duration cannot apply for the program.
However, students who are identified as having special reasons, such as illness or study abroad, may become
eligible for examination with a recommendation letter from their advisers (form M).
◆ Financial Requirements
1. Calculation for financial requirements
Whether the applicant satisfies financial requirements or not is examined based on the assessed household finances(total income minus necessary expenses, predetermined deductions, and standard income of respective household
members). Students to whom the exception criteria are applicable are examined based on more relaxed financial
requirements.
For your reference, a list of income limits for model households is provided below.
2. Income limits for tuition waiver
We have received many tuition waiver/payment deferral applications from students from households with
employment income or income after deduction exceeding the financial requirements (income limits). The
requirements vary depending on numbers of household members, types of income, and special circumstances (e.g.,single-mother/father family), but the table below provides guidelines for making an application. “Employment income”
and “income after deduction” refer to a total of incomes earned by all members sharing household finances.
Please also note that you may not receive a waiver, even if you satisfy the criteria, due to budget constraints.
- 1 -Income limit guidelines

CourseUndergraduate
Master’s
Program
Doctor’s
ProgramNo. ofhouseholdmembers3
2 persons
3 persons
4 persons
2 persons
3 persons
4 persons
2 persons
3 persons
4 persons

Employment income1 (yen)Home

5,785,000
5,657,000
6,457,000
6,128,000
6,057,000
6,780,000
7,390,000
7,530,000
8,210,000

Non-home

6,414,000
6,285,000
6,920,000
6,690,000
6,640,000
7,220,000
7,830,000
7,970,000
8,650,000

Income after deduction2 (yen)Home

3,430,000
3,340,000
3,900,000
3,670,000
3,620,000
4,200,000
4,810,000
4,950,000
5,630,000

Non-home

3,870,000
3,780,000
4,340,000
4,110,000
4,060,000
4,640,000
5,250,000
5,390,000
6,070,000

1 “Employment income” refers to employment income before deduction, which appears as the amount of payment in a

certificate of tax deducted or as the amount of employment income in a certificate of annual income.

2 “Income after deduction” refers to the amount of operating income (amount of income), i.e., sales minus necessary

expenses, for final return.

3 In the table above, the number of household members is based on the following assumptions.

Meanwhile, “home” refers to the case where the applicant is commuting from the house of the head of his/herhousehold, and “non-home” refers to the case where the applicant is living in an apartment, dormitory, etc. away fromhome.
2 persons: Father or mother (key income producer) and the applicant
3 persons: Father (key income producer), mother (full-time homemaker) and the applicant
4 persons: Father (key income producer), mother (full-time homemaker), the applicant and the applicant’s
brother/sister (public high school student commuting from home)◆ Academic criteria

1. Undergraduate freshman and Practical Music Course freshmana. The applicant’s average score provided in the registration form is 3.2 or higher.
b. The applicant’s score of the entrance examination is in the top one third of the applicant’s faculty (major).
c. The applicant has passed the national university entrance qualification examination.
2. Undergraduate sophomore or above
The number of credits earned by the applicant by the previous academic year meets the standard number of credits
earned in the table below. At the same time, his/her credits with grade A or above account for at least two-fifths of the
all credits earned, or his/her academic performance for the year is in the top one third of his/her faculty (major).
3. Practical Music Course sophomore
Grade of credits earned by the previous academic year is A or above.
4. First year in the Master’s or Doctor’s Program(1) With regard to credits earned as an undergraduate if the applicant is in the Master’s Program or credits earned in the
Master’s Program if the applicant is in the Doctor’s Program, the number of credits with grade A or above accounts
for more than two-fifths of the credits earned.
(2)The score of the entrance examination is in the top one third of the applicant’s major.
5. Second year in the Master’s or Doctor’s Program
The number of credits earned by the applicant by the previous academic year meets the standard number of credits
earned in the table below. At the same time, his/her credits with grade A or above account for at least two-fifths of the
all credits earned, or his/her academic performance for the year is in the top one third of his/her major.
Standard number of credits earned

Undergraduate (2nd year): 30
credits
Master’s Program (2nd year): 10
credits
Doctor’s Program (2nd year): 4
credits

Undergraduate (3rd year): 60 credits

Undergraduate (4th year): 90 credits

Doctor’s Program (3rd year): 8
credits* 1 Credits earned from teacher training courses and curator training courses should not be included.
* 2 Students who have earned no credits or very few credits, students who are repeating a year, and students who havebeen enrolled beyond the shortest course duration (4 years for undergraduate, 2 years for Master’s Program and 3
years for Doctor’s Program, excluding the period when a leave of absence was taken) are ineligible for tuition waiver.
However, students who are identified as having special reasons, such as illness or study abroad, may become
eligible for examination with a recommendation letter from their advisers (form M).
[Students to whom exception criteria are applicable]
Students who don’t meet the academic requirements above but fall under the exception criteria below can be examinedbased on the exception academic requirements (for details of the requirements, contact the Educational Affairs Section or- 2 -the Student Support Division).
(1) The applicant’s household is a public assistance recipient specified under the Public Assistance Act or recognized as such.
(2) The applicant or his/her household member is disabled．
(3) The applicant’s household has member(s) receiving a long-term care.
(4) The applicant is an atomic bomb survivor or a child of an atomic bomb survivor.
(5) The applicant’s household is a single-mother or single-father household.

Tuition payment deferral program
The tuition payment deferral program allows, based on examination, students who fall under any of the following criteria
to pay tuition by a deferred payment deadline. It must be noted, however, that even students who receive deferral must
pay tuition no later than the specified payment deadline.

◆ Eligibility criteria(1) The applicant is identified as having difficulty paying tuition by the payment deadline due to financial reasons and has
good academic standing.
(2) The applicant is identified as having extreme difficulty paying tuition because the key income producer of his/herhousehold died or because he/she or the key income producer of his/her household suffered damage caused by wind,flood or other disaster within one year before the tuition payment deadline. However, this criterion doesn’t apply tocases where the applicant or his/her spouse is financially independent or a international student and identified as the
key income producer of his/her household, even if his/her parents have died.
(3) You are recognized as being in other legitimate situations.
(4) Students who have been enrolled for years longer than the shortest course duration cannot apply for the program.
However, students who are identified as having special reasons, such as illness or study abroad, may become
eligible for examination with a recommendation letter from their advisers (form M).

◆ Payment Deadline

Payment deadline will be postponed until the end of September for first semester, or the end of January for second
semester.
For example, there are cases where, as a result of examination, the applicant for tuition waiver receives part of thewaiver and is allowed to pay the balance by the deferred payment deadline.

◆ Financial Requirements

Whether the applicant satisfies financial requirements or not is examined based on more relaxed financial requirements
than those for tuition waiver mentioned earlier.

◆ Academic criteria

1. Undergraduate freshman and Practical Music Course freshman(1) The applicant’s average score provided in the registration form is 2.5 or higher.
(2) The applicant’s score of the entrance examination is in the top two-thirds of the applicant’s faculty (major).
(3) The applicant has passed the national university entrance qualification examination.
2. Undergraduate sophomore or above
The number of credits earned by the applicant by the previous academic year meets the standard number of credits
earned in the table below. At the same time, his/her credits with grade A or above account for at least one fifth of the
all credits earned, or his/her academic performance for the year is in the top two-thirds of his/her faculty (major).
3. Practical Music Course sophomore
Grade of credits earned by the previous academic year is B or above.
4. First year in the Master’s or Doctor’s Program(1) With regard to credits earned as an undergraduate if the applicant is in the Master’s Program or credits earned in the
Master’s Program if the applicant is in the Doctor’s Program, the number of credits with grade A or above accounts formore than one fifth of the credits earned.
(2) The score of the entrance examination is in the top two-thirds of the applicant’s major.
5. Second year in the Master’s or Doctor’s Program
The number of credits earned by the applicant by the previous academic year meets the standard number of credits
earned in the table below. At the same time, his/her credits with grade A or above account for at least one fifth of the
all credits earned, or his/her academic performance for the year is in the top two-thirds of his/her major.
Standard number of credits earned

Undergraduate (2nd year): 30
credits
Master’s Program (2nd year): 10
credits
Doctor’s Program (2nd year): 4
credits

Undergraduate (3rd year): 60 credits

Doctor’s Program (3rd year): 8
credits- 3 -Undergraduate (4th year): 90 credits

* 1 Credits earned from teacher training courses and curator training courses should not be included.
* 2 Students who have earned no credits or very few credits, students who are repeating a year, and students who havebeen enrolled beyond the shortest course duration (4 years for undergraduate, 2 years for Master’s Program and 3
years for Doctor’s Program, excluding the period when a leave of absence was taken) are ineligible for tuition waiver.
However, students who are identified as having special reasons, such as illness or study abroad, may become
eligible for examination with a recommendation letter from their advisers (form M).
[Students to whom exception criteria are applicable]
Students who don’t meet the academic requirements above but fall under the exception criteria below can be examinedbased on the exception academic requirements (for details of the requirements, contact the Educational Affairs Section or
the Student Support Division).
(1) The applicant’s household is a public assistance recipient specified under the Public Assistance Act or recognized as such.
(2) The applicant or his/her household member is disabled．
(3) The applicant’s household has a member who has been receiving a long-term care.
(4) The applicant is an atomic bomb survivor or a child of an atomic bomb survivor.
(5) The applicant’s household is a single-mother or single-father household.

Decision and payment schedule◆ Decision on tuition waiver/deferral requests
The final decision on your tuition waiver or deferral request is scheduled to be made late July for Semester 1 and lateNovember for Semester 2. The decision will be notified to your guarantor by mail, or yourself if you are a foreign student,
and also be posted on the campus bulletin board.
Update your Campus Plan information immediately, if your guarantor or yourself have moved.
https://www.geidai.ac.jp/life/cp/campusplan◆ Payment of tuition
1. If your waiver request is denied or the waiver is granted part of the tuition or your request for payment
deferral is denied:Within 30 days from the day of the notification of the evaluation result (See the note below), you must pay the tuition(or the balance of the tuition if part of your tuition is exempt) with the payment slip that is sent by TUA.
2. If your request for payment deferral is accepted
The payment due of your tuition will be extended to the end of September of the year. Make sure that you will pay thetuition by that due date with the payment slip which will be sent by TUA later(See the note below).
Note: The specific payment due will be informed together with the notification of the denial or other results of youradmission fee waiver request.

Study Support Scholarship* Eligible students for the 2024 academic year are undergraduate students enrolled in the 2023 and2024 academic year and graduate students enrolled from 2020 onwards academic year
This scholarship is for students* who are subject to the revised tuition rates. See the “application guidelines” for details.
Please be advised that applications cannot be accepted from students who have already paid their tuition.
1.Overview
The scholarship in the amount of 50,000 yen will be provided per person per semester if all of the eligibility criteria aremet. (Those who meet household requirements and have filed for tuition waiver but were denied because of
unsatisfactory academic achievement.)
2. Eligible students
For the 2024 academic year, this scholarship is available to undergraduate students enrolled in the 2023 and 2024
academic years and graduate students enrolled from 2020 onwards academic years who have applied for tuition fee
waiver. Please submit your application in addition to that for tuition waiver.
3. How to apply
Complete the scholarship application section on the Tuition Fee Waiver/Deferral Application form (Form B-1). The timing
for distribution of application forms and where to submit completed forms are same as those of application for Tuition Fee
Waiver/Deferral.
4. Notification of results
The selection results will be sent to the applicants around the same time as the announcement of tuition waiver/deferralapproval.
5. Payment of scholarshipStudents selected for the scholarship will be instructed to register their bank accounts under their names with theuniversity. The scholarship money will be transferred to the bank account designated by each recipient by the end of
August for the First Semester and by the end of December for the Second Semester.
- 4 -Submission of request documents
Fill out [Form A] to [Form M] and submit the complete forms on the dates specified below.

If you are an applicant as an international student:
If you are an applicant as an international student (staying with a student visa), you will be considered“Financially Independent” and you must submit documents about your information only, in principle.
*If your spouse is also staying in Japan, you must also submit documents about your spouse.
Documents to submit are: forms indicated as “mandatory” in Form A and documents (1) through (5)below:(1) Certificate of residence (copy): Of your household in Japan. Attach the copy to Form D-1.
Only when a certificate of residence cannot be issued, submit a copy of your alien registration card.
(2) Taxation Certificate/Tax Exemption Certificate Issued by Municipality (copy): Of your household in Japan. Attach
the copy to Form E. Submission is not required if you (and your spouse) have just arrived in Japan and are unable
to obtain the copy.
(3) Copy of bank passbook: If you are receiving financial support for living expenses, etc. from your family in yourhome country, submit Form I by attaching the copy of the passbook page(s) showing the amount sent.
(4) Document(s) on the applicant’s income: If you have earned income from part-time job, scholarship, etc., submit
Form I by attaching a copy of specified documents.
(5) Additional documents may be necessary depending on your (and your spouse’s) circumstances.

Refer to Forms [Form A], [Form C-1] and [Form C-2], and submit all applicable documents.
E.g. If your spouse has income from employment, submit Form F. / If your spouse is a student, submit form K-1.
/ If you or your spouse is a person with a disability, submit Form K-3.

◆ Submission Deadline

September 4 (Wed.)

Postmark deadline

Please send by registered mail to the following address.
Please write in red “CONTENTS: Tuition Waiver and Payment Deferral Application For 2024 Semester 2”
Graduate School of Fine Arts：12-8 Ueno Park, Taito-ku, TOKYO 110-8714
Office of Graduate School of Fine Arts, bijutsu gakubu kyomu kakari
Graduate School of Global Arts：1-25-1 Senju, Adachi -ku, TOKYO 120-0034
Office of Graduate School of Global Arts, senju kyomu kakari◆ Contact
Graduate School of Fine Arts：bijutsu.kyomu@ml.geidai.ac.jp
Graduate School of Global Arts：senju.kyomu@ml.geidai.ac.jp
For inquiries on the payment of admission fee, please contact Financial Accounting div. Accounting sec.

kaikei-keiri@ml.geidai.ac.jp- 5 -[Form A]

Mandatory to submit
Checklist for Submitting 2024 Semester 2
Tuition Waiver/Payment Deferral Application
Applicant (Student ID)

Name

Use this checklist as your cover sheet.
Documents must be submitted (1) A4 paper, (2) single-sided printing, (3) without staples or glue.
Documents not marked as [original] may be submitted as photocopies.
▼Check applicable boxes.

Mandatory□

Mandatory

Mandatory

□
□
□
□
□
□

Submitif applicable□□□

Mandatory□

Only
Undergraduate

Mandatory

Submitif applicable
Submitif applicable
Submitif applicable

Mandatory
Submitif applicable
Submitif applicable
Submitif applicable
Submitif applicable
Submitif applicable

Submitif applicable
Submitif applicable
Submitif applicable

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□
□
□
□
□
□
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[Form A] Checklist for Submitting 2024 Semester 2 Tuition Waiver/Payment Deferral
Application[Form B-1] Tuition Waiver and Payment Deferral Application For 2024 Semester 2[Form B-2] Confirmation of Application type
Document to attach to [Form B-2] (copy acceptable)[Form C-1] List of Household Incomes/Deductions (Incomes)[Form C-2] List of Household Incomes/Deductions (Deductions)[Form D-1] Submission of Certificate of Residence for all Household Members (Including
Applicant and Member(s) Sharing Household Finances but Living Apart)
Document to attach to [Form D-1] (copy acceptable)[Form D-2] Submission of Documents to Certify Financial Independent Applicant
Documents to attach to [Form D-2] (copy acceptable)[Form E] Submission of Taxation Certificate/Tax Exemption Certificate Issued by
Municipality
Document to attach to [Form E] (copy acceptable)[Form F] Employment Income Statement
Document to attach to [Form F] (copy acceptable)[Form G] Own Business Income Statement
Document to attach to [Form G] (copy acceptable)[Form H] Temporary Income Statement
Document to attach to [Form H] (copy acceptable)[Form I] Student Declaration of Part-Time Job
Document to attach to [Form I] (copy acceptable)[Form J] Status of Other National School Student than the Applicant Submit the original[Form K-1] Special Deduction Statement（Household with other student(s) than theapplicant)Documents to attach to [Form K-1]
[Form K-2] Special Deduction Statement (Household with other national school student(s)receiving tuition waiver than the applicant)Document to attach to [Form K-2]
[Form K-3] Special Deduction Statement (Single-mother/father household, household as a public
assistance recipient, household with disabled member(s))

□
□
□
□
□

Document to attach to [Form K-3] (copy acceptable)[Form K-4] Special Deduction Statement (Household with member(s) receiving a long-term
care)Document to attach to [Form K-4] (copy acceptable)[Form K-4 Medical Expense Statement][Form K-5] Special Deduction Statement（Household with the key income producer living apart,household affected by fire, wind/flood damage, burglary, etc., household with income(s) earned by member(s) otherthan parents)□□

Document to attach to [Form K-5] (copy acceptable)[Form M] Recommendation from Advisor of Student with Special Circumstances□ Academic record Submit the original(New student enrolling in TUA’s Master’s or Doctor’s Program from other university)* Not required for a new undergraduate student or new student graduated from TUA.

- 6 -

[Form B-1]

Mandatory to submit

make sure you have your own copy

Tuition Waiver and Payment Deferral Application
For 2024 Semester 2
(MM)

(DD)

, 2024

To: President of the Tokyo University of the Arts

I apply for tuition waiver or deferral for 2024

Semester 2 as below.

▼Check one box for your application.

I apply only for tuition waiver.
I apply only for tuition deferral.
*Deferred payment deadline: To pay by the end of Jan. for semester 2□3. I apply for tuition waiver and deferral.

□1.
□2.

(date specified by TUA)

【Only for the undergraduate students enrolled in the 2023 and 2024 and the graduate students enrolled after 2020 academic year】▼Check the box below if you wish Study Support Scholarship□4. If my application for tuition waiver is disapproved for not meeting the university’s academic standard, I wish
to apply for the Study Support Scholarship.
(Student ID:)

Years in TUA

Major

Applicant・ If you are a new student from a school attached to TUA, provide your former student ID:
・ If you are a new student from other university, provide the name of the university:
You must submit the academic record of the former university.
Name in Kana

Name (autograph)
Address (postal code)[Phone][Mobile phone][e-mail]

Guarantor

Name (e.g., parent )Address (postal code)[Phone]Relation[Mobile phone][e-mail][Reason why you apply for tuition waiver/payment deferral] Must be written in concrete terms by the applicant.
When you need more space, attach a sheet (free format).

Have you ever applied for tuition waiver?
▼Circle all applicable answers.

No
Yes: I made the most recent application for the semester ofSemester 1 / Semester 2 (year)

Application results: Full waiver / 50% waiver / No waiver- 7 -*If the key income producer of your household
died within the past year
His/her nameDate of death:(Relation)

[Form C-1]

Mandatory to submit
List of Household Incomes/Deductions▼Mandatory to fill in
1. Write about all household members (including the applicant and member(s) living apart but sharing
household finances).
(1) Provide household (family) member information as of October 1 for fall semester.
(2) If you need more space, copy this blank form and attach it.
(3) For members who are unemployed, write “unemployed” in the occupation field.

(i) Family members other than students(e.g., parents, grandparents)
Relation
Father (agedName
Occupation)

Mother (aged)

Relation:

(aged

)

Relation:(ii) Family member(s), including the applicant, as a student (excluding preparatory school student)
Relation
Name
SchoolApplicantTokyo University of the Arts▼

No. of household members (i) + (ii)persons

Relation:(aged

National/public/private)

Relation:(aged

National/public/private)

Relation:

(aged

(aged

)

)

National/public/private

If you are a international student (private students), write your information only.
For details, see “If you are an applicant as a international student” on Form D-1.

2. Income of all household members (including member(s) sharing household finances but living apart)▼ Mandatory to fill in (as to all members with income)(i) Employment income▼Provide amounts of income calculated in Form F Employment Income Statement.

Father,000 yen

MotherRelation:
Relation:
Relation:
Relation:,000 yen,000 yen,000 yen,000 yen,000 yen(ii) Income from own business▼Provide amounts of income calculated in Form G Own Business Income Statement.

Father,000 yen

MotherRelation:
Relation:
Relation:
Relation:,000 yen,000 yen,000 yen,000 yen,000 yen(iii) Temporary income from retirement allowance, etc.
▼Provide amounts of income calculated in Form H Temporary Income Statement.

Father,000 yen

MotherRelation:
Relation:
Relation:
Relation:,000 yen,000 yen,000 yen,000 yen,000 yen(iv) Income from part-time job, etc. of the applicant (including the case where the applicant is a international student)▼Provide amounts of income calculated in Form I Student Declaration of Part-time Job.

Income from
Money from
Scholarshippart-time job, etc. family/aid(non-loan),000 yen,000 yen,000 yen

3. Circle “Financially independent” or “International student” if applicable.

▼Financially independent: Form D-2/ International student: Form D-1
Prepare documentation in accordance with the descriptions provided on the applicable form.
The applicant is certified / not certified
Financially independent / International student
as financially independent (To be filled by TUA)

- 8 -

[Form C-2]

Mandatory to submit
List of Household Incomes/Deductions
Applicant (Student ID)

NameHousehold eligible for deduction from income: If your household is identified as any of the households listed
below, the specified amount is deducted from income.
▼Check applicable box(es).
▼Amount deducted☑Home 280 ,000 yen ▲ The deductions on the left are based on where the☑ Deduction by applicant’s
applicant (not his/her brother/sister) commutes from tocommute type□Non-home
TUA. Check the applicable box in the left field.
Applicable to all applicants
720 ,000 yen ※If you are a international student, check the ”Home” box.
,000 yen ▲ In the left field, provide the deduction calculated in□ Household with otherForm K-1 Special Deduction Statement.
student(s) than the applicant▲
In the left field, provide the deduction calculated in□ Household with national
Form K-2 Special Deduction Statement,000
yenschool student(s) receiving
tuition waiver other than theapplicant490,000 yen ▲ Check applicable boxes and provide necessary□ Single-mother/father
information in Form K-3.
householdIncomedeductionisnot▲ Check an applicable box and provide necessary□ Household as a publicavailable but the academic
information in Form K-3, and submit a copy of theassistance recipient and the requirements and income
public assistance notification or other document
like
requirements will be relaxed.
certifying the amount received.
▲ In the left field, provide the deduction calculated inForm K-3 Special Deduction Statement.

□ Household with disabled
member(s)Per disabled member;
860,000 yen x no. of
disabled member□ Atomic bomb survivor orchild of an atomic bomb
survivor

Income deduction is notavailable but the academic
requirements and income
requirements will be relaxed.

□ Household with member (s)receiving or is likely toreceive a long-term (at least
6 months) care
□ Household with the key
income producer living apart□ Household affected by fire,
wind/flood damage,burglary, etc.
□ Household with income(s)earned by member(s) otherthan parents,000 yen▲ Check applicable boxes in Form K-3, and submit a copyof official designation as an atomic bomb survivor andthe like.

,000 yen ▲ In the left field, provide the deduction calculated inForm K-4 Special Deduction Statement.

,000 yen ▲ In the left field, provide the deduction calculated inForm K-5 Special Deduction Statement.

,000 yen ▲ In the left field, provide the deduction calculated inForm K-5 Special Deduction Statement.

,000 yen ▲ In the left field, provide the deduction calculated inForm K-5 Special Deduction Statement.

- 9 -[Form D-1]

Mandatory to submit

Applicant’s student ID
Name

Submission of Certificate of Residence for All Household Members (Including
Applicant and Member(s) Sharing Household Finances but Living Apart)(Copy Acceptable)*Submit a certificate that covers all members of the applicant’s household.
*If the applicant is not living in the address shown in the certificate of residence, a document that proves theapplicant’s current address (e.g., utility bill) must also be submitted.
* The certificate of residence you provide has to be issued within three months prior to the application date.
*The certificate should not contain any information of individual numbers (“My Number”). If only a certificate
with the numbers is available, black out the number information before submission.
Definition of “sharing household finances”“Sharing household finances” does not necessary mean living together. For example, following cases are consideredas sharing household finances: a member who is living apart for the convenience of commuting to work/school or for
medical expenses but lives with his/her family in his/her spare time on a regular basis; and a member to whom thehousehold constantly sends money for living expenses, school expenses, medical expenses, etc.
* Note that applicants with household that does not include his/her parents and meets certain requirements are
identified as “financially independent.”
Financially independent applicants must submit Form D-2 (next page) by attaching specific documents required.

If the key income producer of your household died within the past year, attach the following documents.
(i) Certificate of residence (copy)(ii) Extract of family register (copy)

If you are an applicant as an international student:
If you are an applicant as an international student (private students), you will be considered “Financially
Independent” and you must submit documents about your information only, in principle.
*If your spouse is also staying in Japan, you must also submit documents about your spouse.
Documents to submit are: forms indicated as “mandatory” in Form A and documents (1) through (5)below:(1) Certificate of residence (copy): Of your household in Japan. Attach the copy to Form D-1.
Only when a certificate of residence cannot be issued, submit a copy of your “residence card”. Be sure to submit
the certificate of residence when it becomes available for issuance.
(2) Taxation Certificate/Tax Exemption Certificate Issued by Municipality (copy): Of your household in Japan. Attach
the copy to Form E. Submission is not required if you (and your spouse) have just arrived in Japan and are unable
to obtain the copy.
(3) Copy of bank passbook: If you are receiving financial support for living expenses, etc. from your family in yourhome country, submit Form I by attaching the copy of the passbook page(s) showing the amount sent.
(4) Document(s) on the applicant’s income: If you have earned income from part-time job, scholarship, etc., submit
Form I by attaching a copy of specified documents.
(5) Additional documents may be necessary depending on your (and your spouse’s) circumstances.
Refer to Forms [Form A], [Form C-1] and [Form C-2], and submit all applicable documents.
E.g. If your spouse has income from employment, submit Form F. / If your spouse is a student, submit form K-1.
/ If you or your spouse is a person with a disability, submit Form K-3.

Submit your certificate of residence by attaching to this form.

- 10 -

[Form D-2]

Submit only if applicable

Applicant’s student ID
Name

Submission of Documents to Certify
Financially Independent Applicant

If you seek to be certified as being financially independent, submit the following documents required for
certification.
*Who are financially independent?
Any applicant with a household that does not include his/her parents and the like and meets certain
requirements is identified as “financially independent.”
Even if the applicant student has his/her spouse or child or even if the applicant is a non-working
dependent of his/her spouse, he/she is financially independent as long as he/she meets the requirements.
“Parents and the like” refer to the person(s) who had supported the applicant until he/she became
financially independent.
<Requirements for applicants to be certified as financially independent>
Applicants are certified as financially independent if they meet the following requirements:
Undergraduate: Students who enrolled in TUA after working as a member of society or who have a spouse, and also
meet all the requirements 1 through 4 below as of the time when they apply for admission fee/tuition
waiver/payment deferral
Graduate:
Students who meet all the requirements 1 through 4 below as of the time when they apply foradmission fee/tuition waiver/payment deferral
1. The applicant is not a dependent of his/her parents and the like (excluding his/her spouse) under the Income Tax
Act or in terms of health insurance.
2. The applicant is living apart from his/her (and his/her spouse’s) parents and the like.
3. The applicant is not receiving financial assistance from his/her parents and the like (excluding his/her spouse).
4. The applicant meets any of the requirements (1) through (3) below:(1) In the previous academic year, the applicant (including his/her spouse) had a regular income exceeding
1,300,000 yen a year and declared the income on which a certificate of annual income can be issued, andthe situations remain the same this academic year.
(2) In this academic year, the applicant (including his/her spouse) is likely to have an income (including annual
amount of non-loan scholarship and employment income) exceeding 1,300,000 yen because of a new job
he/she has taken on or for other reasons, and can submit a certificate or other document supporting theestimation (see 3 of <Documents to submit> below). If you cannot submit a supporting document, you are
regarded as not meeting this requirement.
(3) The applicant had a steady job and earned a salary or other income until the previous fiscal year, butbecame unwaged as he/she quit the job or took a leave of absence to enroll in TUA. He/she is now living on
the money saved from the job and his/her deposit balance exceeds 1,300,000 yen.
*Even when the amount specified in (1) through (3) is less than 1,300,000 yen, please consult if you are in
special circumstances, such as not having parents nor other supporter (excluding spouse). It must be noted,
however, that you are not certified as financially independent just because you are not receiving money fromyour parents.
<Documents to submit>
1. [All applicants who desire to be certified as financially independent and meet requirement 4 (1)]Copy of a certificate of residence, certificate of annual income, certificate of tax deducted or final return of theapplicant and his/her spouse, parents and the like→ Submit the document by attaching to the form specified for each document type.
2. [All applicants who desire to be certified as financially independent]
Health insurance card with the applicant (or his/her spouse) heading the list of the insured→ Submit the card by attaching to this Form D-2.
3. [Applicants who meet requirement 4 (2)]Certificate of salary payment (schedule), letter of appointment as researcher at the Japan Society for the
Promotion of Science, or document that shows the amount of scholarship, etc.
→ Submit a document showing the applicant’s income and a document showing his/her spouse’s income byattaching to the form specified for each document type.
4. [Applicants who meet requirement 4 (3)] Balance statement of the applicable bank account→ Submit the statement by attaching to this Form D-2.

Submit your health insurance card and balance statement by attaching to this form.

- 11 -

[Form E]

Mandatory to submit

Applicant’s student ID
Name

Submission of Taxation Certificate/Tax Exemption Certificate Issued
by Municipality (Copy Acceptable)

Certificate for 2024
(Income from January to December 2023)「令和６年度（令和５年分）」市区町村発行の「課税証明書（所得証明書）」または「非課税証明書」* 1. If you are required to submit your taxation certificate or tax exemption certificate
・ Submit the certificate for you as the applicant and all members of your household.
・ Submit the certificate for a member sharing household finances with the applicant even if he/she is living
apart.
→ See Definition of “sharing household finances” on Form D-1 and Requirements for applicants to becertified as financially independent on Form D-2.
・ Submission of a certificate is not required for other student(s) sharing household finances than theapplicant.
* 2. Certificate to submit (taxation certificate or tax exemption certificate)・ If you have earned an income, you must submit a document titled “taxation certificate,” “certificate ofannual income” and the like.
・ If you have not earned an income, you must submit a tax exemption certificate.
Submission of a tax exemption certificate is required even if the applicant earned no income (but notrequired with regard to student(s) other than the applicant).
・ A taxation certificate can be called by a different name depending on the municipality. Submit a certificatethat shows the amount of income, amount of deduction, and amount of resident tax (income-based levy
and per capita basis). The amount of resident tax may be marked as “0 yen” or “excluded from taxation”★In a taxation certificate or tax exemption certificate issued, the monthly amounts of tax for themonths of January through May reflect the data for the year before last and those for June throughDecember reflect the data for the last year.
★You should request the office of the municipality in which you are living now to issue acertificate, in principle. If you have relocated this year, you should request the office of themunicipality in which you lived before the relocation to issue a certificate.
★If you were not residing in Japan on January 1st of this year, enter your date of entry below.

▼Fill in if applicable
I (will) enter(ed) Japan on (MM)(DD)

, 2024, so this certificate will not be issued.

Submit the abovementioned document by attaching to this form.
- 12 -

[Form F]

Submit only if applicable

Applicant’s student ID
Name* Submission unnecessary for student(s) (excluding the applicant and his/her spouse)

Employment Income Statement

1.

Submit this form for each of applicable income producers in your household. Copy this form in advance to complete this form for all
income producers.
2. As for income earned from part-time job and the like by the applicant, submit Form I Student Declaration of Part-time Job.
Income producer’s name:
Father / Mother / Other ()
Document tosubmit (copyThis form must be submitted by a person who falls under any of the following. (Check the applicable box and provide
acceptable)
necessary information.)▼
Certificateof□ Salary□ Taking the current job since January 2023 or before
tax deducted orProvide the amount of payment stated in the certificate of tax deducted for last year
□ Wagecertificate of(January through December 2023).
□ Executive(expected)
yenremuneration
payment issued(including white□ Started (or will start) to take the current job this year or have been taking the job with by the employer
return)mid-career employment/job change since February 2023 or later* Even an income* If receiving from
Calculate the amount based on the certificate of tax deducted or certificate of payment
producer
multiple sources,
issued by the employer
submitting a final
provide the total
return (copy)
15
monthsamount.
must submit aMonthly payment
yen ×= Equivalent of annual incomeyencertificate of tax
12 months
deducted.
(If without income from bonus such as in a part-time job, multiply by 12 months)↑ If received payment for 5 months, write the one fifths of the amount paid.
* Retirement allowance (including that of a person expected to retire) should be provided inForm H Temporary Income Statement.
Notification of(expected)□ Unemployment □ Benefit received since April 2024 (Unnecessary to include the benefits received inunemployment
and before March)
benefitbenefit
Benefits received from April 2024 to expirationyeneligibility issued
by ajob-placement
officeNotification of□ Pension□ Receiving since January 2023 or before(expected)
Provide the amount of pension stated in the certificate of tax deducted for last year
□ Governmental
pension issued(January through December 2023).
pensionby the Social□ Old-ageyenInsurance
pensionAgency, etc. or□ Survivor’s□ Started (or will start) to receive this year (2024) or have been receiving before
certificate of tax
pension, etc.
maturity since February 2023 or later
deducted* If receiving from
Calculate the amount based on the notification of pension.
multiple sources,
Monthly payment
yen × 12 months = Equivalent of annual income
yen* Final returnprovide the total(copy) cannot be↑
Ifreceived
paymentfor5months,
write
the
one
fifthsoftheamountpaid.
amount.
accepted□ Accident andsicknessbenefits□ Livelihood
assistance□ Disability
benefit□ Children's
allowance* If receiving frommultiple sources,
provide the total
amount.

□ Receiving since January 2023 or before
Provide the amount of benefit stated in the notification of accident and sickness benefits forlast year (January through December 2023).
yen□ Started (or will start) to receive this year (2024) or have been receiving before
maturity since February 2023 or later
Calculate the amount based on the amount of benefit stated in the notification of accident
and sickness benefits.
Monthly payment
yen × 12 months = Equivalent of annual incomeyen↑ If received payment for 5 months, write the one fifths of the amount paid.

Notification of(expected)
accident andsicknessbenefits issued
by the Social
Insurance
Agency, etc. or
welfare(change)notification
issued by awelfare office▼

Add up all incomes above (round down to the thousand) →▼Write the total amount in Form C-1 List of Household Incomes/Deductions.

Submit the abovementioned document by attaching to this form.
- 13 -,000 yen[Form G]

Submit only if applicable

Applicant’s student ID
Name* Submission unnecessary for student(s) (excluding the applicant and his/her spouse)

Own Business Income Statement

1.

Submit this form for each of applicable income producers in your household. Copy this form in advance to complete this form for all
income producers.
2. As for income earned from part-time job and the like by the applicant, submit Form I Student Declaration of Part-time Job.
Income producer’s name:
Father / Mother / Other ()
Document tosubmit (copyThis form must be submitted by a person who falls under any of the following. Check the applicable box and provide
acceptable)
the information.
▼
Tables
1 & 2 of□ Commerce□ Doing the current business since January 2023 or before
final return
With regard to the income in final return (copy) filed this spring, add up the positive□ Industry(copy) declaredamounts only (Do not write the total amount).
□ Self-employed
this spring
If only negative amounts are written in final return, write “0 yen” instead of adding up□ Agriculture* If final return was
positiveandnegativeamounts.
If receiving
not filed, submit a
Income from salary or public pension should not be included in this form but in Form F
rice-crop
document that
Employment
IncomeStatement.
diversionshows businessyen
income,subsidy, also fillnecessaryin the field
expenses andbelow.
□ Doing the current business started/changed since February 2023 or later
income after□ Forestry
With regard to the income in final return (copy) filed this spring, add up the positive
deduction in theamounts only (Do not write the total amount). Calculate an equivalent of monthly income to recent few□ Fisheries
determine an equivalent of annual income.
months.
□ Freelance*
IMPORTANT:
If
only
negativeamountsarewrittenin
final
return,
write
“0
yen”
insteadofaddingup□ House rent
Final return (copy)
positive and negative amounts.
□ Land rent
must have a
Income from salary or public pension should not be included in this form but in Form F□ Interest/“Received” stamp
Employment Income Statement.
on it (if final return
dividend
Equivalent of monthly income
yen x 12 months
was filed via□ Other= Equivalent of annual incomeyen
e-tax, submit adocument proving↑“Equivalent of monthly income”: If having income for five months, for example, write the onethat final return
fifths of the amount.
□ Started (or will start) the current business this year[□Started □Will start in (month)2024]
Expected monthly income
yen x 12 months= Expected annual income□ Agriculture
Rice-crop
diversion
subsidy

was filed).

yen□ Receiving since January 2023 or before
Provide the amount of rice-crop diversion subsidy stated in the mutual compensation
notification or the farming improvement subsidy notification for last year (January throughDecember).
yen□ Started (or will start) to receive this year (2024) or have been receiving before
maturity since February 2023 or later
Provide the amount of rice-crop diversion subsidy stated in the notification of mutualcompensation or notification of farming improvement subsidy.
yen▼
Add up all incomes above (round down to the thousand) →▼Write the total amount in Form C-1 List of Household Incomes/Deductions.

Submit the abovementioned document by attaching to this form.

- 14 -

Statement by
the businessowner, etc. (freeformat)Notification of(expected)
mutualcompensation
issued by JA or
notification of(expected)
farming
improvement
subsidy issuedby municipality,000 yen[Form H]

Submit only if applicable

Applicant’s student ID
Name* Submission unnecessary for student(s) (excluding the applicant and his/her spouse)

Temporary Income Statement

Submit this form for each of applicable income producers in your household. Copy this form in advance to complete this form for all
income producers.
Income producer’s name:

Father / Mother / Other ()

This form must be submitted by a person who falls under any of the following. Check the applicable box and provide
the information.
Amount of (expected) income received in 6 months between April 2024 and September 2024
□ Retirement
allowance
Deduct taxes and dues if there are any.
□ Retirement
yenlump sum□ Income fromtransfer ofasset□ Forestry
income□ Other* If receiving frommultiple sources,
provide the total
amount.

▼Add up all incomes above (round down to the thousand) →▼Write the total amount in Form C-1 List of Household Incomes/Deductions.

Submit the abovementioned document by attaching to this form.

- 15 -

Document tosubmit (copyacceptable)▼
Certificate of(expected)
payment issued
by the employer,
municipality, etc.

,000 yen[Form I]

Mandatory to submit

Applicant’s student ID
Name

Student Declaration of Part-Time Job

Document to submit(copy acceptable)▼

Chapter
1. Income from January 2023 to date

*Write the regular income and current job
Part-time job, etc. (If you are ainternational student, also statemoney/aid from home country.)

Period received (MM/YY–MM/YY)—(i) (Average) amount received per month x 12 months(Average) amount received per
month
yen

—

yen

—

yen

—

yen

—

yen

—

yen
yen

＝

(i) Certificate of tax
deducted or pay
statement issued
by your current
employer(ii) Tables 1 & 2 offinal return (copy)
declared this spring(iii) Certificate of(expected)
payment issued byyour current
employer
Any of (i) through (iii)aboveattach the copy of the
passbook page(s) orapp screenshot
showing the amounttransferred from yourfamily*Submission
unnecessary for TA,RAor Work Study at TUA

2. Non-repayable scholarship received or scheduled to receive between April 2024 and March 2025 *Unnecessary to provide information of loan scholarship provided by the Japan Student Services Organization(JASSO), etc.
If you have been selected as the non-repayable scholarship after April, you must apply for modification in thesemester 2.
Scholarship nameAmount received per monthAmount received per year
yen

yen

yen

yen

yen

yen

(ii) Total amount received per yearyen

3. Applicant’s monthly financial standing
Estimate the annual budget from now on, as well as average monthly budget* Match the total income and the total expenses.
* Match average monthly budget of part-time job or savings and “(Average) amount received per month” inabove 1. Income from January 2023 to date

If the spouse has income, include it in "Other".
yen
yen

Loan scholarshipyen
JASSO Scholarship etc. that you must repay
Non-loan scholarshipyen
Scholarship that you don’t need to repay
Savings
Other(
Total)

Monthly expenses

Monthly incomesPart-time job
Money from family/aid

Copy of scholarshipnotification

Food
Rent

yen
yen

Utilities
Schoolyen
yen

Excluding the applicant’s tuition of 650,000 yen

yenTransportation
Entertainment

yen
yen

yen

Other

yen

yen

Total

If savings is included
as income, submit a"Certificate ofBalance", a copy ofthe pass book or App
screenshot etc.
*Japanese (orEnglish) translationand yen conversion (ifit’s foreign
currencies) arenecessary*Attachdocumentation of theexchange rate basisyen

I declare that the above information is true and correct.
Applicant’s name:▼Write Each of the incomes (i) (ii) in Form C-1 List of Household Incomes/Deductions.

Submit the abovementioned document by attaching to this form.
- 16 -

[Form J]

該当者のみ提出

申請者学籍番号 Applicant’s student ID

Submit only if applicable

氏 名 Name

本人以外の「国立学校」就学者状況票（国立学校在学者用）
Status of Other National School Student than the Applicant (For national school student(s) in the applicant’s household)
１．この状況票は、下記の「国立学校」に就学する家族を対象としています。
(1)対象となる就学者：２年生以上全員 （ただし、学部から学部へ入学等、同じ課程に再入学した新入生は、提出が必要）(2)対象となる「国立学校」：高校、高等専門学校、短大、大学、専修学校（高等課程・専門課程）※国立学校であっても「幼稚園」「小中学校」「専修学校の一般課程」「各種学校（盲学校、ろう学校）」は提出不要です。
２．この用紙は、１人１枚ずつ使用してください。足りない場合は、あらかじめ人数分をコピーしてください。
３．該当項目にチェックの上、記入してください。
1. This form must be submitted with regard to student(s) as the applicant’s household member(s) enrolled in any of the national schools listed
below.
(1) Applicable student: Student in the second year or above (However, submission required for first-year students re-entered the same course, e.g.,
an undergraduate student entered a national university after being an undergraduate at other university）(2) Applicable national school: High school, specialized vocational high school, junior college, university, specialized training college (upper secondary
course/post-secondary course)* Submission unnecessary for kindergarten, elementary school, junior high school, general course at specialized training college, special school forthe blind, the deaf and the like
2. Submit this form for each of applicable students in your household. Copy this form in advance to complete this form for all applicable students.
3. Check applicable boxes and provide necessary information.

▼就学者が在学する学校で証明を受けてください。
Please receive certification by the school the household member is enrolled in.

国立学校「授業料免除」状況証明書
National School Tuition Waiver Certification【学校種別】[School type]□高校 High school □高等専門学校 Specialized vocational high school □短期大学 Junior college □国立大学法人National university□専修学校 Specialized training college □高等課程 Upper secondary course □専門課程 Post-secondary course
学校名 School name
担当係 殿
Responsible staff（
年度入学）(Enrolled in the year)（
年 years at the school）
学生番号 Student ID：
氏 名 Name
Commuting from□自宅通学Home□自宅外通学Non-home

東京芸術大学に在学する私の兄弟姉妹が授業料免除を申請するために必要としますので、私の下記事項について証明願います。
I request a certification on the following information, which my brother/sister attending the Tokyo University of the Arts needs to apply fortuition waiver.
記

２０２３年度授業料免除状況 Tuition Waiver in Academic Year 2023
※授業料免除の有無に関わらずご記入願います* Please fill in the following field whether the student received tuition waiver or not.

授業料[年額]Tuition [per year]円
yen□一部免除part of the waiver (免除額

前期

□申請なしNot applied for waiver□不許可Waiver not allowed

Seme□半額免除Received 50% waiver□全額免除Received full waiverster 1□国費留学生Government-sponsored international student

後期□申請なしNot applied for waiver□不許可Waiver not allowed

Seme□半額免除Received 50% waiver□全額免除Received full waiverster 2□国費留学生Government-sponsored international student

円)□休学Took leave of absence□一部免除part of the waiver (免除額円)

□休学Took leave of absence

上記のとおり証明します。I certify that the above information is true and correct
令和

年

月

日Date (MM/DD/YY)

学校名 School name
所属 Department
担当者氏名 Responsible person
電話番号 Phone

この証明書は、証明を受けた後、【Ｋ票-1】または【Ｋ票-２】に重ねて提出してください。
Receive certification in this form and attach to Form K-1 or Form K-2.
- 17 -㊞Seal

[Form K-1]

Submit only if applicable
Applicant’s student ID
Special Deduction Statement Name

Use this Special Deduction Statement to calculate a certain amount that can be deducted from income if it is certified thatthe applicant’s household meets the following requirement.
2. Check applicable boxes and provide necessary information. Submit this form with the below-mentioned document attached.
Requirement
Special deduction
Document tosubmit ▼Household* 1 Write the school type as of April 1 if applying for semester 1 waiver or as of October (i) Copy ofwith other1 if applying for semester 2 waiver.
school ID
student(s) than * 2 “Study abroad” should be counted as “private” whether the institution is national,
card orpublic, or private.
the applicant
student ID
Excluding the* 3 Deduction is not available for a specialized training college general course,
card (bothfollowing:
preparatory school, or vocational school.
sides)▼(ii) Form J* If the student is □ Elementary school student(80,000 yen x
persons =yen)Status ofenrolled in a
□ Junior high school student(160,000 yen x
persons =
yen)
Other
national□ National/public high school student
National
university and□ Home(280,000 yen x
persons =yen)Schoolreceiving□ Non-home(470,000 yen x
persons =yen)Student
tuition waiver,than thecomplete Form □ Private high school student□ Home(410,000 yen x
persons =yen)ApplicantK-2 (next□ Non-home(600,000 yen x
persons =yen)(Submissionpage).
unnecessary□ National/public specialized vocational school student
for public and□ Home(360,000 yen x
persons =yen)private□ Non-home(550,000 yen x
persons =yen)school□ Private specialized vocational school student
students)□ Home(600,000 yen x
persons =yen)□ Non-home(800,000 yen x
persons =yen)* Submission□ National/public university student (undergraduate, graduate, junior college)
unnecessary forelementary and□ Home(590,000 yen x
persons =yen)junior high□ Non-home(1,020,000 yen x
persons =yen)school students□ Private university student (undergraduate, graduate, junior college)
and students on□ Home(1,010,000 yen x
persons =yen)which Form J is
□ Non-home(1,440,000 yen x
persons =yen)submitted.
□ National/public specialized training college student (upper secondary course)* If the submitted* General course students are ineligible.
certificate of□ Home(170,000 yen x
persons =yen)residence and□ Non-home(270,000 yen x
persons =yen)copy ofschool/student□ Private specialized training college student (upper secondary course)
ID card cannot* General course students are ineligible.
prove the fact of□ Home(370,000 yen x
persons =yen)commuting from
□ Non-home(460,000 yen x
persons =yen)non-home,□ National/public specialized training college student (post-secondary course)
attach a copy of* General course students are ineligible.
utility bill (with□ Home(220,000 yen x
persons =yen)name and□ Non-home(620,000 yen x
persons =yen)address printed).
□ Private specialized training college student (post-secondary course)* General course students are ineligible.
□ Home(720,000 yen x
persons =yen)□ Non-home(1,120,000 yen x
persons =
yen)
1.

▼
Add up all deductions above (round down to the thousand) →▼Write the total amount in Form C-2 List of Household Incomes/Deductions.

,000 yen

Submit the abovementioned documents by attaching to this form.

[Reference: Key school types]
1. Specialized vocational high school: Accepts persons graduated from junior high schools to teach specialized knowledge and skills anddevelop necessary vocational abilities with educational continuity for five years.
2. Specialized training college upper secondary course: Admits persons graduated from junior high schools to provide them with educationaccording to mental and physical development based on the foundation of junior high school education. Can be called high school.
3. Specialized training college post-secondary course: Admits persons graduated from high schools to provide them with education based on
the foundation of high school education. Can be called technical college.
4. Specialized training college general course: No particular requirements for admission are specified. Provides education other than thatprovided in the upper secondary course and post-secondary course.

- 18 -

[Form K-2]

Submit only if applicable
Applicant’s student ID
Special Deduction Statement Name

Use this Special Deduction Statement to calculate a certain amount that can be deducted from income if it is certified thatthe applicant’s household meets the following requirement.
2. Check applicable boxes and provide necessary information. See key school types on Form K-1.
Requirement
Special deduction
Document tosubmit ▼Household with This field should be filled in if the student(s) received full waivers for both semester 1[Form J] Status
other nationaland semester 2.
of Other National* If the waiver received is full or 50% waiver, part of the wavier only for semester 1 or semester School Student
school2, fill in the field below.
student(s)than the Applicant
receiving tuition □ High school student
waiver than the□ Home(280,000 yen x
persons =yen)applicant□ Non-home(470,000 yen x
persons =yen)▼□ Specialized vocational school student
Provide□ Home(360,000 yen x
persons =yen)information□
Non-home(550,000yenxpersons=yen)based on the□ University student (undergraduate, graduate, junior college)certification in□ Home(280,000 yen x
persons =yen)[Form J] Statusof Other□ Non-home(720,000 yen x
persons =yen)National School □ Specialized training college student (upper secondary course)
Student than the* General course students are ineligible.
Applicant.
□ Home(170,000 yen x
persons =yen)□ Non-home(270,000 yen x
persons =yen)□ Specialized training college student (post-secondary course)* General course students are ineligible.
□ Home(200,000 yen x
persons =yen)□ Non-home(600,000 yen x
persons =yen)This field should be filled in if the student(s):(i) received 50% waiver or part of the wavier for both semester 1 and semester 2 ; orProvide the“tuition paid” in(ii) received full or 50% waiver, part of the wavier only for semester 1 or semester 2.
the past year (ifreceived waiver,□ High school student
write the amount□ Home(280,000 yen + tuition paid x
persons =yen)after waiver).
□ Non-home(470,000 yen + tuition paid x
persons =yen)□ Specialized vocational school student□ Home(360,000 yen + tuition paid x
persons =yen)□ Non-home(550,000 yen + tuition paid x
persons =yen)□ University student (undergraduate, graduate, junior college)□ Home(280,000 yen + tuition paid x
persons =yen)□ Non-home(720,000 yen + tuition paid x
persons =yen)□ Specialized training college student (upper secondary course)* General course students are ineligible.
□ Home(170,000 yen + tuition paid x
persons =yen)□ Non-home(270,000 yen + tuition paid x
persons =yen)□ Specialized training college student (post-secondary course)* General course students are ineligible.
□ Home(200,000 yen + tuition paid x
persons =yen)□ Non-home(600,000 yen + tuition paid x
persons =
yen)
1.

▼
Add up all deductions above (round down to the thousand) →,000 yen* When the total calculation of Form K-2 exceeds the deduction allowed than the applicant in Form K-1,
write the Form K-1 deduction as the upper limit.

▼
Write the total amount in Form C-2 List of Household Incomes/Deductions.

Submit the abovementioned document by attaching to this form.

- 19 -

[Form K-3]

Submit only if applicable
Applicant’s student ID
Special Deduction Statement Name

Use this Special Deduction Statement to calculate a certain amount that can be deducted from income if it is certified thatthe applicant’s household meets any of the following requirements.
2. Check applicable boxes and provide necessary information.
Requirement
Special deduction
Document tosubmit (copyacceptable) ▼* Deduction for single-mother/father household is applicable when any of the following
TUA will confirm□ Singlerequirements is met.
with themother/▼ Check an applicable box.
certificate offatherresidence
household □ The household consists of a mother/father and a child or children under 18 years old
submitted.
□ The household consists of a mother/father, a child or children under 18 years old, and* Unnecessary toMother:grandparents aged 60 years or older lacking economic resources
attach to thisdied / separated □ The household consists of a child or children under 18 years oldform.
□ The household consists of grandparents and a child or children under 18 years old□ The household consists of unmarried brother(s)/sister(s) and a child or children under 18
Father:years olddied / separated□ The household consists of unmarried brother(s)/sister(s), a child or children under 18 years
old, and grandparents aged 60 years or older lacking economic resources1.

□ Household
as a public
assistancerecipientand the like
□ Householdwithdisabled
member(s)* 1. Any student, including the applicant, aged 18 years or older and lacks economic
resources because of long-term care or mental or physical disability should be counted
as a member under 18 years old.
* 2. Grandparents lacking economic resources refer to:(i) those who received payment of 1,660,000 yen or less if employment income is the only
source of income; and(ii) those who have income (income minus necessary expenses) of 500,000 yen or less if
the income is own business income.
Deduction (flat rate)□ 490,000 yen* Besides the deduction above, academic requirements will be relaxed (but standard income will
not be relaxed).
Deduction is applicable when the applicant is a member of a household identified as a
Copy of public
public assistance recipient and the like.
assistance* When this requirement is met, deduction from income is not available but academic
notification or
requirements and standard income will be relaxed.
other document
certifying theamount received* Deduction for the disabled is applicable when any of the following requirements is met. Copy of▼ Check an applicable box.
disability
certificate,□ The disabled member is a person described as physically disabled in the disability
certificate ofcertificate issued pursuant to Article 15, paragraph 4 of the Act on Welfare of Physicallymental disorder
Disabled Persons, and the like.
□ The disabled member is an officially certified victim of pollution-related illness and has aphysical disability due to the pollution.
□ The disabled member was exposed to an atomic bomb and has an impaired physicalfunction.
□ The disabled member lacks the capacity to appreciate his/her situation due to mental
disability, or has been determined as mentally disabled.
□ The disabled member needs to stay in bed and requires complicated care.
* Note that expenditures related to corrective treatment for the disabled can be deducted if thehousehold meets the requirement for a household with member(s) receiving a long-term (atleast 6 months) care stated in Form K-4.
Deduction (flat rate) * Besides the deduction below, academic requirements and standard
income will be relaxed.
□ 860,000 yen/disabled member ×
persons =yen(i) Disabled member’s name:(ii) Disabled member’s name:▼Write the total amount in Form C-2 List of Household Incomes/Deductions.

□ Atomicbomb
survivor orchild of an
atomicbomb
survivor* When this requirement is met, deduction from income is not available but academic
requirements and standard income will be relaxed.

Submit the abovementioned document by attaching to this form.
- 20 -

Copy of official
designation as
an atomic bomb
survivor[Form K-4]

Submit only if applicable
Applicant’s student ID
Special Deduction Statement Name

Use this Special Deduction Statement to calculate a certain amount that can be deducted from income if it is certified thatthe applicant’s household meets the following requirement.
2. Check applicable boxes and provide necessary information.
Requirement
Special deduction
Document tosubmit (copyaccepted) ▼□ Household * Deduction for household with member(s) receiving a long-term care (limited to those who Copy of doctor’shas been receiving, or is certified as requiring, care for at least 6 months to treat an illness as certificate
withof the time of application) is applicable to any of the following medical treatment
acceptable
member(s)(the certificate
receiving (or expenses incurred.
* Note that the deduction is not applicable if treatment has finished as of the time ofmust confirm thelikely toapplication.
need for care forreceive)
6 month or longer
long-term▼ Check a box of applicable medical treatment expense.
and issued within(at least 6
3 months),□ Medical service fees paid to a doctor or dentist
months)and receipt andcare (to treat □ Charges for hospitalization
the like (based
an illness)□ Treatment fees paid to a practitioner of massage, acupuncture, moxibustion,
on diagnosis;
Judo-orthopedics, etc.
copy
□ Drugs and medicines for treatment or care
acceptable)□ Transportation to get outpatient treatment (limited to necessary transportation)issued by□ Fees paid to a caretaker (including board)
hospital,
Amounts paid out of pocket for services received by a person certified as being in need ofpharmacy and thecare or assistance pursuant to the Long-Term Care Insurance Act (The deduction is not
likeapplicable to fees for doctor’s certificate and private room.)* Receipts to be
attached must
▼ Medical expense calculation
be those issued
Calculate medical expenses based on (v) Amount paid to date in Form K-4 Medicalin the past year
Expense Statement.
and bundled per
Based on the amount paid by the time of application to treat the member currently
month.
receiving care, calculate the amount (to be) paid for the expected period under carein one year, taking into account how long the care receiver is likely to remain undercare.
* Note that the amount of medical benefits to receive pursuant to the Health Insurance Act, etc.
and the amount covered by compensation damage should be subtracted from the amount
paid.
Care receiver’s name:
Period under care: from (MM/YY)
to (MM/YY)(estimate)
Period (up to 12 months)
Amount paid to dateNo. of months
Monthly average
(v)
yen ÷
month =
yen ×
months =yen
Care receiver’s name:
Period under care: from (MM/YY)
to (MM/YY)(estimate)
Period (up to 12 months)
Amount paid to dateNo. of months
Monthly average
(v)
yen ÷
month =
yen ×
months =yen
Care receiver’s name:
Period under care: from (MM/YY)
to (MM/YY)(estimate)
Period (up to 12 months)
Amount paid to dateNo. of months
Monthly average
(v)
yen ÷
month =
yen ×
months =yen
1.

▼
Add up all deductions above (round down to the thousand) →▼Write the total amount in Form C-2 List of Household Incomes/Deductions.

* Besides the deduction above, academic requirements and standard income will be relaxed.

Submit the abovementioned documents by attaching to Form K-4,
together with medical expenses calculated.

- 21 -,000 yenSubmit only if applicable (for each care receiver)[Form K-4 Medical Expense Statement]
Applicant: Student ID () NameCare receiver’s name:▼ Check a box of applicable medical treatment expense.

□ Medical service fees paid to a doctor or dentist□ Charges for hospitalization□ Treatment fees paid to a practitioner of massage, acupuncture, moxibustion, Judo-orthopedics, etc.
□ Drugs and medicines for treatment or care
□ Transportation to get outpatient treatment (limited to necessary transportation)□ Fees paid to a caretaker (including board)

Amounts paid out of pocket for services received by a person certified as being in need of care or assistance pursuant to theLong-Term Care Insurance Act (The deduction is not applicable to fees for doctor’s certificate and private room.)

Hospital (facility) name:
Type of health insurance:□National □Social □medical care system for elderly in the latter stage of life
Date
(YY/MM)

Total(i)
Hospitalization(ii) Outpatient
treatment(iii) Care service(paid out of
pocket)

yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen

yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen

yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen

□Other ()(iv) Amount covered bycompensation(v) Amount paid todate(i) + (ii) + (iii) - (iv)for high medical expense, fringe
benefit paid to family, etc.

yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen (v)▼Write (v) Amount paid to date in the field of medical expense calculation in Form K-4 Special Deduction Statement tocalculate the medical expenses.

- 22 -

yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen
yen

[Form K-5]

Submit only if applicable
Applicant’s student ID
Special Deduction Statement Name

Use this Special Deduction Statement to calculate a certain amount that can be deducted from income if it is certified thatthe applicant’s household meets any of the following requirements.
2. Check applicable boxes and provide necessary information.
Requirement
Special deduction
Document▼* The amount of deduction should be as follows.
Receipts□ Household* 1. The income of the household earned by the key income producer living apart should beof paymentswith the key
his/her income, not the amount sent to the household, and special expenses paid to live
made andincomeapart should be deducted from the income.
certificate ofproducer living* 2. Money sent to dependent(s) living apart is ineligible for deduction.
paymentapart▼ Estimate the amount to be paid per year based on the amount paid until the time showing actualof application.
payment madefor housing,Amount paid to dateNo. of months
Monthly averageutilities, furniture,* Upper limit 710,000 yen
etc. issued by the(i)yen ÷ (ii)months = (iii)yen× (iv) 12 months =yenoffice (both copy
Total of deductions above (round down to the thousand),000 yen
acceptable)▼
Write the total amount in Form C-2 List of Household Incomes/Deductions.
* The amount of deduction should be as follows, in principle.
Disaster victim□ Household
Limited to cases where it is certified that the household will be in financial distress in thecertificate issued
affected byby firefire, wind/flood future (for more than 2 years) with increasing expenses or decreasing incomes due todamage caused from the previous year of this application to datedepartment/
damage,* 1. Note that deduction is not applicable if the damage was covered by insurance or damage municipality orburglary, etc.
compensation.
certificate of* Household* 2. Note that the amount of deduction will not be the actual damage or repair cost.
stolen property
affected by
If you take casualty loss deduction on income tax, deduct the amount.
reportthe Great East
issued by police□ Damage of daily necessitiesJapan
station (copyEarthquake
Minimum clothes, furniture, repair, etc:
yen
acceptable)
andDamage details (Please specify):
andKumamoto□ Damage of means of production (farmland, store, etc.)
Copies of receipt
Earthquake
Expected long-term decrease in annual income:yens to verify theshould fill in
Damage details (Please specify):
amount ofthis field.
Total of deductions above (round down to the thousand),000 yendamageEstimate▼
damage of theWrite the total amount in Form C-2 List of Household Incomes/Deductions.
previous1.

academic
year, not of
the timefollowing theearthquake.
* Deduction (upper limit per person: 380,000 yen)
□ Householdwith income(s) An applicable deduction is determined based on the table below. However, if one income producer has both
employment income and own business income, write the upper limit of 380,000 yen.
earned by▼ [Formula] Check an applicable box.
member(s)Income type
Income or income after deduction
Formulaother thanNo deduction
parents□ 1,040,000 yen or lessSalary,(excluding the□ Exceeding 1,040,000 yen but under Income minus (income × 0.2 + 830,000 yen)pension, etc.
applicant and
1,512,500 yen
his/her spouse)
Deduct a flat rate of 380,000 yen as upper limit□ 1,512,500 yen or more
Own businessincomeDeduct the amount of income after deduction
Deduct a flat rate of 380,000 yen as upper limit□ Under 380,000 yen□ 380,000 yen or more

Deduction qualifier’s name:
Deduction qualifier’s name:
Deduction qualifier’s name:

Deduction:
Deduction:
Deduction:

yen
yen
yen

Total of deductions above (round down to the thousand),000 yen▼
Write the total amount in Form C-2 List of Household Incomes/Deductions.

Submit the abovementioned documents by attaching to this form.

- 23 -

Submission ofcertifying
document
unnecessary[Form M]

Submit only if applicable
この書式は、指導教員作成用として Word 形式でもダウンロードできます。

修得単位皆無者・修得単位不足者・留年者・標準修業年限超過者のうち特別事情者の指導教員推薦書
Recommendation from Advisor of Student with Special Circumstances

東京藝術大学長 殿
推薦学生：学籍番号

令和

年

月

日

学生氏名

上記の学生は特別事情に該当すると判断しましたので推薦します。
推薦者（指導教員署名）㊞※非常勤の先生等、他の先生と連署等が必要な場合は、推薦欄、署名等を振り分けるなど、適宜ご記入願います。

（注）特別事情による留年又は標準修業年限（休学期間を除き、学部４年間、修士２年間、博士３年間）を超過できる期間は、原則として学部・修士は１年間、博士は２年間とします。

ただし、学長が真にやむを得ない事情があると特に認めた場合には、１年を超えることができます。
↓該当する事項の［ ］に○を入れ（複数可）、次頁に該当事項についての詳細な事情を記入願います。
（１）病気 診断書(写)を添付 ※病気には外傷を含むが、法令等に違反した行為が原因の場合は除く［ ］イ 長期療養のため、休学期間(2 年間)を超えてさらに授業を休む必要があり、単位修得ができなかった。
［ ］ロ 休学期間に満たない期間の病気のため単位修得ができなかった。
［ ］ハ 単位修得試験の当日の病気により単位修得ができなかった。
［ ］ニ 上記以外（学長がこれらの事例と同等以上の事情があると特に認めた場合に限る）（２）留学［ ］イ 留学のため、標準就業年限内での単位修得ができなかった。（本来の学業修得のため真に有益であるとは認められない留学や留学期間が概ね半年未満の留学は除く）［ ］ロ 上記以外（学長がこれらの事例と同等以上の事情があると特に認めた場合に限る）（３）大学院学生の論文作成［ ］イ 研究テーマ、研究方法等、本人の側の事情によらない理由で留年又は標準修業年限を超過。
※本人と指導教員とで協議の上、正式に承認された研究計画に基づく在学延長であること（本人の自己都合のみによる留年ではないこと）を具体的に次頁に記入願います。
［ ］ロ 上記以外（学長がこれらの事例と同等以上の事情があると特に認めた場合に限る）（４）その他［ ］イ 出産･育児のため、休学期間(2 年間)を超えてさらに授業を休む必要があり、単位修得ができなかった。
［ ］ロ 国又は地方公共団体等の求めに応じて公共的な事業に参加するため、休学期間(2 年間)を超えてさらに授業を休む必要があり、単位修得ができなかった。
［ ］ハ 学資負担者の不在や被保護世帯のため、学業と平行して学資獲得のためのアルバイト又は常勤の業についた。
［ ］ニ 本人が身体障害者［ ］ホ 上記以外（学長がこれらの事例と同等以上の事情があると特に認めた場合に限る。なお、国家試験等の受験、 大学院の 受験、 転学・ 転学 部等 の 受験、 就職のため等、自己都合により、留年又は標準修業年限を超過している場合は除く）- 24 -

【Ｍ票：推薦書】＜推薦理由を記入する際の注意点＞◆前項で○を付けた特別事情についての具体的な説明を、必ず詳細に記入願います。
◆記入の際には、学生支援室等で配布している「授業料免除および徴収猶予 留年・修業年限超過者の取扱について（「特別事情者」の考え方）」を参照してください。
◆「大学院学生の論文作成」が理由の場合、本人と指導教員とで協議の上、正式に承認された研究計画に基づく在学延長であること（本人の自己都合のみによる留年ではないこと）を具体的に記入願います。
◆「病気」が理由の場合、裏付けとなる医師の診断書（コピー可）の添付が必要です。
推薦学生：学籍番号

学生氏名

推

薦

- 25 -

書