THE UNIVERSITY OF TOKYO

DIVISION OF ENVIRONMENTAL STUDIES

APPLICATION FOR ADMISSION TO GRADUATE PROGRAM

Academic Year 2011 Photo

(3cm × 4 cm)
Type or write in block letters.

1. Name: ( )Mr. ( )Ms.

Family name First name Middle name(s)

2. Date of Birth: 3. Age (as of coming April):

（Month/Day/Year）

4. Nationality: 5. Marital status: ( ) Single ( ) Married

6. Present status with the name of the university or of the employer:

7. Present mailing address:

8. E-mail address:

9. Phone No. : 10. Fax No. :

11. Permanent address, if different:

12. Degree objective: ( ) Master of Environmental Studies ( ) Doctor of Environmental Studies

( ) Master of International Studies ( ) Doctor of International Studies

13. Major field of interest, if any:

(1)

(2)

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14. Academic Background:

Name of School and Year and Month Period Major Category of Class average
Location of of earned and/or GPA
Entrance/Com attending degree/diplo
pletion ma
Sample (name) (from) Years
Kashiwa E.S. April 1985 And General
(location) (to) Month
Chiba, Japan March 1991
Elementary (name) (from)
Education Yrs.
Or (location) (to) And
Elementary
School Mos.
Secondary (name) (from)
Education Yrs.

(location) (to) And

Or Mos.
(name) (from)
Lower and Yrs.
Upper
Secondary (location) (to) And
School
Mos.

Higher (name) (from)

Education Yrs.

Or (location) (to) And

Undergrad
uate Level Mos.

Graduate (name) (from)

Level Yrs.

(location) (to) And

Mos.
Others (name) (from)
Yrs.

(location) (to) And

Mos.

Total of schoolings
Yrs.

15. Will you apply for financial aid through the University of Tokyo? ( ) Yes ( ) No

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16. Names of two persons whom you have requested to write a letter of recommendation:

Name Title Institution

(1)

(2)

17. Professional experience, if any. List names of employers, job titles and duration, starting with the most recent
employment.

Employer Title Duration

(1)

(2)

(3)

(4)

(5)

18. List of other graduate schools you are applying to:

University Financial Aid

(1)

(2)

(3)

19. Statement of Study Plan. Please include an outline of your research, motivation of your subject choice or
reasons. This statement must be written on a separate sheet of paper.

20. For our information, please inform us how you got to know our program. Please check X.

(1) ADB website ( ) (2) Other website, in details ( )

(3) Your supervisor ( ) (4) Your friends ( )
(5) Your university ( ) (6) Local media, such as newspaper ( )
(7) Others ( )

I hereby confirm that information I’ve given in this application form is complete and accurate.

Signature: Date:

This completed application, official certified of diploma, official transcript from each college-level institution previously attended or
presently attending, and two confidential sealed letters of recommendation with signature across the seal should be enclosed in an
envelope and be forwarded to:

International Liaison Office, Graduate School of Frontier Sciences

The University of Tokyo
Chiba, JAPAN

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