October 2022 /April 2023 ENROLLMENTAPPLICATION FOR ADMISSION※ For graduate admission use only

受験番号Examinee’s Number

OVERSEAS SPECIAL ADMISSION EXAMINATION FOR INTERNATIONAL STUDENTS
OKAYAMA UNIVERSITY (MASTER’S COURSE)

岡山大学大学院自然科学研究科外国人留学生海外特別入試入学願書
Please type or write in Japanese or English in block letteryear

申請年月日 Date of application

month年月day日
写真
出願前３か月以内に上半身，無帽，正面向きで撮影したものを貼り付けてください。
Paste your photograph taken within
the past 3 months. Write your nameand nationality in block letters on theback of the photo.
（Photo４×３㎝）

ENGLISH
Family Name/SurnameFirst Name/Given nameMiddle Name

Please handwrite your full name above（氏名を自署してください。）
生年月日 Date of Birthyear年month

国籍 Nationalityday

月

性別 SexAge日（満男 ・ 女歳）

MaleFemale

現住所Current Address

電話

Fax

Telephone number

E-mail

志望先 Desired Division, Department, etc.

※You must get Letter of Acceptance from your prospective supervisor before you send this application form.
志望専攻 Desired Division

志望講座 Desired Department

志望教育研究分野 Desired Research Areas

指導予定教員教 授 ・ 准教授

Prospective SupervisorProf.

Associate Prof.

出身大学 Previous University or most recent educational background
国名 Country学位Degree

卒業年度
Date of graduation

出願区分 Enrollment

学校名 Name of University or Institution

専攻 Division(Research field)

Bachelor ofyear

年month月day日□ 卒業 Graduated □ 卒業見込み Expected to Graduate

いずれかにチェック (Please check the appropriate box below)□ ２０２２年１０月入学 October 2022 Enrollment□ ２０２３年４月入学 April 2023 Enrollment

受験番号
CURRICULUM VITAE 履歴書
１ 氏 名：(Name)，(Family name)署名(First name)(Middle name)(Signature)※Write your name by yourself in Block Letters
２ 性 別： □ 男 (Male)□ 女 (Female)

３ 国 籍：(Sex)(Nationality)

４ 生年月日：(Date of Birth)

年Year月Month日 （満Day歳）（２０２２年５月１日現在）

Age(As of May 1, 2021)

５ 現住所 (Present mailing address)
住所:(Address)
電話:(Telephone number)
６ 家族連絡先(Person to be notified in applicant’s home country, in case of emergency)
氏 名(Name)
住 所(Address)
電 話(Telephone number)

続柄(Relationship)

７ 学歴(Educational Background)
Name and Address of School（学校名及び所在地）
Higher
Education（高等教育）
Undergraduate
Level
（大学）

Name（学校名）

Location（所在地）Year and Month of Entranceand Completion（入学及び卒業年月）
From（入学）

Major Subject（専攻科目）

Diploma ofDegree Awarded（学位・資格）

To（卒業）* In the case the blank spaces above are insufficient for information required, please attach an additional sheet to this form.
（（注）上欄に書ききれない場合には，適当に別紙に記入して添付してください。
）

８ 賞罰・資格等(Reward and Punishment, License)

受験番号

入学検定料支払証明書

Official entrance examination fee payment certificate
入学検定料の支払後にダウンロードできる書類を印刷し入学検定料支払証明書を点線に沿って切り取り，以下へ貼付してください。
Please print documents that can be downloaded after payment of the entrance examination fee, cut the entrance examination fee payment
certificate along the dotted line, and paste it to the following.
この部分に糊を付け剥がれないように貼り付けてください

Please paste the receipt in thissection using glue so that thereceipt does not become
unfastened.

受験番号LETTER OF RECOMMENDATIONName of applicant:(Form 1)，

(Family name)(First name)(Middle name)To the Recommender (the director of affiliated laboratory or the head of university department (President or Dean)),
The person named above is applying to Overseas Special Admission Examination for International Students of Okayama University (Master’sCourse). We should appreciate it very much if you would let us know your confidential opinion of the applicant’s academic abilities andpotential for research, together with some comments on his/her personality, in the following form.

To: President,Okayama University

Date:
Recommender
Signature:
Name:
Position and Institution :Present Address:
Please seal the envelope securely, and sign over the seal before returning it to applicant .The applicant will turnforward your recommendation to us with the application form. Thank you.

受験番号LETTER OF RECOMMENDATIONName of applicant:(Form 2)，

(Family name)(First name)(Middle name)To the academic advisors of the applicant,Please rate the applicant relative to other students in the same field in recent years.

EVALUATION
50%
Average

Top 20%GoodTop 10%

Top 5%
ExcellentTop 2%

Academic abilities
English proficiency

We should appreciate it very much if you would let us know your confidential opinion of the applicant’s academic abilities and potential for
research, together with some comments on his/her personality, in the following form.

To: President,
Okayama University

Date:
Recommender
Signature:
Name:
Position and Institution:
Present Address:
Please seal the envelope securely, and sign over the seal before returning it to applicant .The applicant will turnforward your recommendation to us with the application form. Thank you.

受験番号

Letter of Acceptanceby Prospective Supervisor
受入内諾書

氏 名

殿(Name in Block Letters)

岡山大学大学院自然科学研究科が行う（２０２２年１０月入学／２０２３年４月入学）
博士前期課程外国人留学生海外特別入試に合格し，入学をした場合，指導教員となることを内諾します。
If you pass the Overseas Special Admission Examination for International Students this time, I willagree to become your academic adviser.

年

指導予定教員Prospective Supervisor

月日

所 属Department of affiliation

氏 名印

NameSeal※ 指導予定教員は，作成した受入内諾書を PDF ファイル等にして，志願者へファイルデータを送付してください。
受入内諾書の原本は，理学部事務室教務学生担当へ提出してください。