How to fill out the Admission Application Card for Master's Course of Health Sciences,
Graduate School of Health Sciences, Kumamoto University
1. Type of examinations“Type of examinations”“Application No.”
2. Major and course of your choice“Major of your choice”“Course of your choice”

3. Name“Name in English”
4. Date of birth, age, and gender“Date of birth”“Age”“Gender”
5. Eligibility for Application“University from which you graduated”“Identification code of your university”“Expected (to graduate) or Graduated”“Year and month of (expected) graduation”

6. Address“Current address”“Emergency contact address”
7. Others“Working adult applicants”“Type of international students”* Former student No.
“Former student No.”

Reverse side: Resume“Academic background”

Circle the type No. that applies.
Do not fill in.
Do not fill in.
Enter the name of the course of your choice and the following code that applies:
Course of Nursing
01
Course of Radiological Sciences
02
Course of Medical Laboratory Sciences
03
Course of Genetic counseling04Enter your first name and family name separately in the respective spaces.
Enter your date of birth in the relevant space in an 8-digit number in order of year (4digits) followed by month (2 digits) and date (2 digits).
(e.g. Born on May 10, 2002→ 2002510)
Enter your current age.
Circle the number that applies.
Circle one of the numbers for “National,” “Public” and “Private” that applies to theuniversity from which you graduated or are expected to graduate. Then enter theinformation regarding the university in each space. If you have graduated from an
educational institution other than a university, enter as much detailed information on
the institution as possible.
Enter the 4-digit identification code of the university from which you graduated(left-justified), referring to Table 2.
If no code on the table corresponds to your university, enter the 6-digit code 999999.
(e.g. Kumamoto University → 0384)
Circle the number that applies.
Enter the year and month of graduation in a six-digit number in order of year (4digits) followed by month (2-digits).
(e.g. Graduated (expected to graduate) in March 2025→ 202503)
Enter your current address, postal code and phone number.
Enter your contact information where you can be reached in an emergency except
for the current address, if you have.
If your situation after enrolled in this Graduate School will match the description
below, circle “1”; and if it does not, circle “2.”Working to make a constant income from salary, wage or compensation.
(Including those who have resigned from a company and homemakers)
If you are an international student, circle the number of the description that applies.
If not applicable, do not circle any number.
If you are currently enrolled in a school/department of Kumamoto University as a
research student or other status and are applying to the Graduate School of HealthSciences for admission after your graduation/completion, enter your current student
No. If not applicable, leave the space blank.
International applicants must fill out the form from a school equivalent to a Japaneseelementary school. For all others, please fill in from high school graduation.

AY2025 Admission Application Card for Graduate School of Health Sciences,
Kumamoto University (Master’s Course)
1. Type of examinations
Graduate School ofHealth Sciences

Master’s Course

121.

Term of admission

01

01

General entrance
examination
International student
entrance examination

Type ofexaminations

2.

0Course of yourchoice

ApplicationNo.*J

2. Major and course of your choice
Major of yourchoice

Program of Health Sciences

Majorcode

1CoursecodeCourse

3. NameFirst nameName in English

Last name

4. Date of birth, age, and gender
Date of birth

AgeDayMonthGender

1. Male2. FemaleYear

5. Eligibility for Application (university from which you graduated/are expected to graduate)
Location of youruniversity

Type of youruniversity

Identification codeof your university

1. National
2. Public
3. Private

Expected to graduate orGraduatedName of your university

1. Expected to graduate
2. GraduatedName of your department/course

Year and monthof graduation

6. Address
Postal code:
Current address

Emergency contactaddress(mobile phone, etc.)

Phone
E-mail(Phone()@Postal code:)

7. Others
Working adultapplicants

1. Yes2. No

Type ofinternational
students

1. Government-sponsored
3. Prefecture-sponsored
5. At own expense

2. Dispatched by the government
4. Municipal-sponsored* Former student No. (for Graduates of Kumamoto University)
Former student
No.

Notes: 1. Fill out this Admission Application Card clearly in block letters using a black pen or ball-point pen, after
carefully reading “How to fill out the Admission Application Card” on page 11.
2. Do not fill in “Application No.*”.
3. Please also fill out the reverse side.

Personal history
Admission year/monthType

Academicrecord（Year/Month）（Year/Month）（Year/Month）（Year/Month）（Year/Month）（Year/Month）（Year/Month）（Year/Month）（Year/Month）

Employment （record

Description

Graduated fromHigh School

Year/Month）（Year/Month）（Year/Month）（Year/Month）（Year/Month）

Rewards andpunishments （Year/Month）（Year/Month）

Notes: 1. As for the academic record, international applicants should enter all of their school education history,
and other applicants should enter their academic history from their high school graduation.
2. Admission of those who have made any false statement in their personal history may be revoked.

AY2025 Graduate School of Health Sciences, Kumamoto University (Master’s Course)
Photo Card for Entrance Examination
Type ofGeneral entrance examination / International student entrance examination
examinations

Application No.

*JPhotoName inEnglish(4 cm × 3 cm)
Photo taken within
three months before

The course of your choiceYour choice

application, frontal

Course ofportrait, no hat

Note: 1. Do not fill in the space marked with an asterisk (*).
2. Circle the type of examinations that applies.

------------------------------------------------- Do not separate these forms.-------------------------------------------------AY2025 Graduate School of Health Sciences, Kumamoto University (Master’s Course)
Admission Ticket to an Entrance Examination
Type ofGeneral entrance examination / International student entrance examination
examinations

Application No.

*JName inEnglishName of the courseYour choice

Course ofNote: 1. Do not fill in the space marked with an asterisk (*).
2. Circle the type of examinations that applies
3. This ticket must be placed on the desk and visible to the supervisor when you are taking the examination.
4. This ticket should be kept until completing the enrollment procedure.

------------------------------------------------- Do not separate these forms.-------------------------------------------------AY2025 Graduate School of Health Sciences, Kumamoto University (Master’s Course)
Address Card for Entrance Examination
Type ofGeneral entrance examination / International student entrance examination Application No.
examinations(Postal code)

Mailing(Ward/Town/Village)
address for
notificationof acceptance(Applicant’s name)Note: 1. Do not fill in the space marked with an asterisk (*).
2. Circle the type of examinations that applies(Pref.)(Street No./Bldg./Room No.)

(C/O, if any)

*J
(City/County)Important notes:
1. You must bring your Admission Ticket with you and place it on the desk while taking an examination.
2. Please turn off your mobile phone(s).
3. Latecomers for an examination due to unavoidable circumstances will be allowed to take theexamination only if it is within 30 minutes from the start of the examination.

Date of examination

Subjects
Written examination

August 17 (Sat), 2024

Oral examination

TimeVenue
Graduate School of HealthSciences, Kumamoto
University

Note: 1. The time of each examination will be announced when the examination voucher is sent.

Application No.

*J

Reason for Application & Desired Research Form
Graduate School of Health Sciences, Kumamoto University (Master’s Course)

Name

Course ofyour choiceAcademicsupervisor

Supervisor’s
Signature

I. Reason for application (Reason for choosing the Graduate School of Health Sciences)

II. Research of your choiceNotes:

1. Do not fill in the space marked with an asterisk (*).
2. Please see “Full-time Supervisors and Research Themes” for “Course of your choice.”
3. Be sure to have your academic supervisor’s signature on the form before submitting.

Application No.

*

AY2025 Graduate School of Health Sciences, Kumamoto University(Master’s Course) Application Form for Screening of Eligibility for Application
Name in English
Signature

Date of birth

Course &Discipline/Dept. ofyour choiceYear/

CourseYears/months of admission andgraduation
FromYear/Month（ToYear/Month（FromYear/Month（ToYear/Month（FromYear/Month（ToYear/Month（FromYear/Month（ToYear/Month（FromYear/Month（ToYear/Month（FromYear/Month（ToYear/Month（GenderMale

FemaleFromYear/Month（ToYear/Month（FromYear/Month（ToYear/Month（FromYear/Month（ToYear/Month（FromYear/Month（ToYear/Month（FromYear/Month（ToYear/Month（FromYear/Month（ToYear/Month（Discipline/Dept.

Names of schools (names offaculty/department/course)

Qualifications (degrees)

Names of companies, etc.

Tasks/duties））））））））））））

PeriodEmploymentrecordMonth//Contact information(Phone number,etc.)

AddressAcademicrecordDay/））））））））））））

Note: Do not fill in the space marked with an asterisk (*).