“Study Abroad” as defined in Article 153 of the Undergraduate Rules and Regulations
and Article 124 of the Graduate Rules and Regulations
1.

Application Procedures
Follow the procedures in the order shown below.
*The necessary procedures vary between your affiliation, so please confirm with the Academic Affairs Group in the Officeof Student Services or the section in charge of academic affairs on your campus.
1) Fill out all the required items on the Application for Study Abroad, affix any necessary seals, and attach all the relevant
documents to the application. Have the Academic Affairs Group in the Office of Student Services (or the section in chargeof academic affairs on your campus) check the application and give you a seal of reception.
2)
3)

2.

Submit the application to your academic counselor or academic advisor for a seal of approval.
Upon the completion of the procedures above, submit the application to the Academic Affairs Group in the Office of StudentServices (or the section in charge of academic affairs on your campus).

Acceptance to Study Abroad
After deliberations by the Faculty Board (Graduate School Committee), a notification will be sent directly to your guarantor.

3.

Period of Study Abroad
The study abroad period is limited to a maximum of one year per application. If you plan on extending your period of study
abroad, you must submit the Application for Study Abroad (Extension) following the procedures in 1 above, and receive approval.
The extension of study abroad is approved only once (twice for graduate students).

4.

Tuition Reduction
If undergraduate students go on privately funded study abroad programs after enrolling at Keio University for more than one
year, or if graduate students go on a privately funded study abroad, they will receive reductions in tuition, facility andequipment fees, and experiment and practical training fees by the semester. A notification regarding procedures for reduction
will be sent to the student's guarantor after the Application for Study Abroad is approved by the Faculty Board (Graduate SchoolCommittee). For details, please consult the Academic Affairs Group in the Office of Student Services or the section in chargeof academic affairs on your campus.

5.

Procedures upon Completion of Study Abroad
Please submit a Notification of Returning to Study.
Those who wish to transfer credits for courses taken at their host university should consult the Academic Affairs Group in
the Office of Student Services or the section in charge of academic affairs on your campus. Depending on your undergraduate
faculty or graduate school, credit transfer may be mandatory, so please confirm with the Academic Affairs Group in the Officeof Student Services or the section in charge of academic affairs on your campus.

Undergraduate Rules and Regulations (excerpt)
Article 1531)

The University may permit a student to study abroad at another university without taking a leave of absence
if this is deemed to be in the educational interests of the student.

2)

The period of any study abroad up to one year maximum shall be included in calculating the number of years ofenrollment at the University.

3)

Up to 30 credits earned while studying abroad may be counted toward the number of credits required to graduate
from the University. However, in the Faculty of Economics, Faculty of Policy Management, Faculty of Environment
and Information Studies, and Faculty of Nursing and Medical Care, up to 60 credits earned at another university
or equivalent institute of research and learning may be counted toward the number of credits required to graduate
from the University.

4)

Apart from the study abroad in Clause 1) of this Article, the University may permit a student to register for
subjects offered at overseas partner universities while remaining enrolled at the University, in the case of
study abroad as part of a degree program provided in collaboration with an overseas university, such as but
not limited to a double degree program.

5)

Detailed regulations concerning study abroad shall be stipulated separately.

Graduate Rules and Regulations (excerpt)
Article 1241)

A student may be permitted to study abroad at a graduate school of an overseas university without taking a leaveof absence if this is deemed to be in the educational interests of the student by his/her graduate schoolcommittee.

2)

The period of any study abroad up to a maximum of one year shall be included in calculating the number of yearsof enrollment at the University. However, up to 2 years maximum may be counted in the case of doctoral programsin the Graduate School of Medicine.

3)

Up to 10 credits for subjects earned while studying abroad may be counted toward the number of credits required
to satisfy the degree requirements.

4)

Detailed regulations concerning study abroad shall be provided for separately.

*Regulations for Keio Law School differ, so please contact the section responsible for the Law School for more information.

2017.10版

国 外 留 学 申 請 書 ( 新 規 ・ 延 長 )※Application for Study Abroad (New / Extension)*＊。

就
学の際
は就
学
届を提出してください

慶應義塾大学長殿年月日（提出）To the President of Keio UniversityYear

MonthDay (Submitted)

本保 証 人Guarantor
Information

年組Major

YearClassGraduateSchool専攻Major

学籍番号Student ID Number

年Year

現 住 所 〒
フリガナ
氏 名（）

TEL（）

E - mail

フリガナ

氏

TEL

Current
Address㊞
Seal

現 住 所㊞
Seal名

Name〒Current
Address

留学の目的
Purpose of
Study Abroad

留学する大学

大学名

所在国・都市

Host University

Name of University

Location (City/Country)

Period ofStudy Abroad

Submit a Notification of Returning to Study when returning to Keio.

専攻

Department
修士 ・ 博士 専門職学位 課程
Master's/Doctoral/Professional Degree
Program

Name

留学期間

*

学科

Faculty研究科

人StudentInformation

学 部

留学先での身分※
Status at the
Host University*

今回の申請期間（1年を限度とします）

年月日 ～年月

Application period (one year maximum)

YearMonthDay -YearMonthDay

留学予定（延長を含む）の全期間

年月日 ～年月日

MonthDay -YearMonthDayYear

Total planned period of study abroad (including any extensions)Non-degree Undergraduate Student
1 学部特別学生

2 学部正規学生

3 大学院特別学生 Non-degree Graduate Student
5 その他 Other （詳細に記入してください Write in detail ：科目名

単位数

Course Name

Credits

留学する大学で履修する予定科目名
および単位数日

Full-time Undergraduate Student

4 大学院正規学生 Full-time Graduate Student
科目）
単位数名

Credits

Course Name

Course Names andCredits to betaken at the HostUniversity

留学の種類※
Type ofStudy Abroad*奨 学 金※Scholarships*

1 交換留学（義塾と外国の大学との間に結ばれた交換協定に基づき, 義塾が派遣する留学）
Student Exchange Program (Study abroad program based on agreements signed between Keio and universities abroad)
2 私費留学（「交換留学」以外の留学）
Privately Funded Study Abroad (Any study abroad other than the Student Exchange Programs)（名称 Name of scholarship(s) ：Currently receiving
1 受けている）
Not receiving any scholarships
2 受けていない（名称 Name of scholarship(s) ：）3 留学中に受給予定 Planning to receive scholarship(s) while abroad
奨学金・経済支援制度を受けている者は, この届を提出する前に必ず奨学金担当窓口で手続をしてください。
Those currently receiving scholarship(s) or financial aid must visit the Scholarships and Financial Assistance Group on their campus
before submitting this application.

【添付書類 Documents to Attach】
1 「交換留学」の場合は, 下記の ② ③ を添付してください。
If you are going to study abroad on one of the Student Exchange Programs, please attach items ② and ③ listed below.

2 「私費留学」の場合は, 下記の ① ② ③ を添付してください。ただし, 延長の場合③ ④を添付してください。
If you are going on a privately funded study abroad, please attach items ①, ②, and ③ listed below. However, if you are applying to extend your study abroad,please attach ③ and ④.

①入学願書(写)Application for Admission (copy)②入学許可書(写)Acceptance Letter (copy)
Course Descriptions③講義内容④留学先大学の在学証明書 Certificate of Enrollment at the Host University＊添付書類には,それぞれ右上に上記書類の番号（①～④）を記入してください。
*Please indicate which item is which by writing ① - ④ on the top right corner of each document.

【記入上の注意 Instructions on Filling Out This Form】
1 太線の枠内のみ消えないペンで記入してください。 Fill out the part inside the bold lines using an indelible pen.
Both student and guarantor must stamp their seal or sign their signature.
2 本人、保証人それぞれ自署、押印してください。
For items with an asterisk (*), please circle the applicable option.
3 ※印欄は, 該当事項を○で囲んでください。
4 留学は1か年を限度に許可します。今回の申請期間, 留学予定の全期間いずれも記入してください。留学が延長となる場合は，再度「国外留学申請書」を提出してください。
Study abroad is limited to a period of up to one year maximum for each application. Make sure to fill out the study abroad period for this application as well as thetotal planned period of study abroad. If you wish to extend your period of study abroad, you will have to submit another Application for Study Abroad.

学 事 担 当受 付 印

学習指導・専攻担任
確 認 欄

教 授 会
研究科委員会許 可

年月日

年・減 免 学 期

否月日

学事

担当年度 春 ・ 秋

予定データ入力

年月日 ㊞

年度 春 ・ 秋

入力データ作成年月日 ㊞

2021.03