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APPLICATION FOR ADMISSION TO THE INTERNATIONAL SUMMER PROGRAM

ON
SUSTAINABLE WATER MANAGEMENT
Tokyo and Tsukuba, Japan, 27 July – 7 August 2015

Submit the completed form by via email (wci@hydra.t.u-tokyo.ac.jp) by 31 May 2015

PERSONAL DATA

1. Full name:__________________________________________________________
As written in your passport

2. Date of birth:_________________________ 3. Gender: Male Female


Year /Month/Day

4. Citizenship:______________________________________
As written in your passport

5. Present Affiliation (Educational institution including Faculty and Department in case of students/ Name of

employer’s organization):__________________________________________________________________________

_______________________________________________________________________________________________

6. Present level of study (for students – undergraduate/graduate/postgraduate)/ Present Position:__________________

_______________________________________________________________________________________________

7. University/ Work Address:_______________________________________________________________________

____________________________________________________ Zip Code:_____________________________

Phone:_______________________ Fax:_______________________ Email:_____________________________


Country code – complete number Country code – complete number

8. Home Address:________________________________________________________________________________

____________________________________________________ Zip Code:_____________________________

Phone:_______________________ Fax:_______________________ Email:_____________________________


Country code – complete number Country code – complete number

9. Present Mailing Address: Home Work Other – please specify below:

____________________________________________________ Zip Code:_____________________________

Phone:_______________________ Fax:_______________________ Email:_____________________________


Country code – complete number Country code – complete number
APPLICATION INFORMATION
10. List names and locations of undergraduate and graduate institutions attended, with dates of attendance and degrees
attained or expected.

Elementary – Secondary education (before higher education):

Dates (from - to):____________________________ Period of schooling:__________________________


Year/month – Year/month No. of years and No. of months

Higher Institution and location Dates (from –to) Period of Degree Major
Education: Year Month schooling
Undergraduate years
level
months

Graduate years
level
months

years
Total years of schooling
(including elementary and secondary education) months

11. List all previous employment, starting with your current employment.

Name of organization and location Dates (from - to) Job title and description (in max. 20 words)
12. Explain your motivation for participating in the course. If you are a student, describe what you are most interested
in and summarize your present research focus. Otherwise summarize your present duties and responsibilities. (max
200 words).

13. English language ability. While we do not request any official certificate of your English language proficiency, we
request your own sound judgment in this respect as the course will be conducted in English and will be concluded by
participants’ presentation in English.

I hereby confirm that my English language skills are sufficient to undertake the subject course that will be conducted
in English:
Yes No

14. The course is designed as a complete unit and no partial participation is allowed. Participants are expected to
attend the full period of the course from Monday 27 July through Friday 7 August 2015.

I hereby confirm that I will participate in the full course from 27 July through 7 August 2015:

Yes No
15. Financial support. Participation in the course is exempted from any tuition fee and the organizers will cover all
costs associated with accommodation and local transportation. Generally, participants are expected to cover the cost of
their travel from their residence to Tokyo and back from Tsukuba and their daily subsistence allowances during the
period of the course. Additional support may be provided to participants coming from developing countries to cover
travel costs between their country and Japan and their daily subsistence allowance during the period of the course.
However it is not automatically assured to every such participant. If you are a citizen of a developing country and
residing presently in a developing country, please respond to the following question.

Will you apply for the additional financial support (please choose one):

Yes, I will.

No, I will obtain funding from another source/institution.

No, I will finance myself.

CERTIFICATION

I certify that to the best of my knowledge all the information given above is correct and complete,
and I understand that any omission or misinformation may invalidate my admission or result in
dismissal.

________________________________________________ _______________________
Signature of applicant Year/Month/Day

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