"2012 Application Form"
APPLICATION FORM Master of Science in Sustainability, Development, and Peace United Nations University - Institute for Sustainability and Peace September 2012 Enrolment SECTION 1: APPLICANT DETAILS Attach your photo taken 1. Full name in block capitals within the last 6 months. Family First Middle Write your name and nationality in block letters on the back of the photo. (H: 45mm, W: 35mm) 2. Nationality(ies) 3. Age on 1 September 2012 4. Date of birth (dd/mm/yyyy) 5. Gender 6. Marital status 7. Current occupation (e.g. affiliation and position), including name of the university attended or employer Position: Affiliation: 8. Current mailing address Telephone No., starting with a country code (+ )- 9. Home country address (if different from above) Telephone No., starting with a country code (+ )- 10. E-mail address: Please provide one email address (case sensitive) and type it in uppercase for confirmation. Case sensitive: Uppercase: E-mail will be the primary method of contact. Therefore, it is essential that you provide a valid e-mail address here and that you regularly check your e-mail. SECTION 2: EDUCATIONAL BACKGROUND 1. Please provide details about your higher education. [Undergraduate Education] Name of Institution (include City / Country): Name of Department: Subject / Major Field: Period attended (mm/yyyy): From to Degree Awarded: Title of Thesis (if available): Grade Point Average or class rank (if available): Page 1 of 5 [Postgraduate Education] Name of Institution (include City / Country): Name of Department: Subject / Major Field: Period attended (mm/yyyy): From to Degree Awarded: Title of Thesis: Grade Point Average or class rank (if available): 2. Please list all schools attended including higher education institution in chronological order, starting with primary school: Period at School (mm/yyyy) Diploma/degree Location Name of School From To obtained or (City / Country) expected *If the blank spaces above are not sufficient for the information required, please attach a separate sheet. 3. Please list articles, books, or other material published under your name, if any, with the name and address of the publisher and the date of publication. If necessary, please attach an additional sheet. SECTION 3: PROFESSIONAL BACKGROUND 1. Please list full-time positions, starting with the most recent employment. Employment Period Location Name of Organization/Company Job Title (mm/yyyy) (City / Country) From To *If the blank spaces above are not sufficient for the information required, please attach a separate sheet. Page 2 of 5 SECTION 4: ENGLISH LANGUAGE LEVEL *Applicants who are exempt from submitting a score sheet are not required to fill in 1 & 2. Please refer to page 4 of Application Guide for details regarding exemptions. 1. Please indicate your English level. Reading Excellent Good Fair Writing Excellent Good Fair Listening Excellent Good Fair Speaking Excellent Good Fair 2. English proficiency qualification. *Original score sheet must be submitted. Name of Test Test Date (dd/mm/yyyy) Score TOEFL - Paper-Based Testing (PBT) TOEFL - Internet-Based Testing (iBT) IELTS - Academic format SECTION 5: REFERENCES Please list two persons who are familiar with your qualifications and character, and who have agreed to write a letter of reference on your behalf. 1. Name: Position/Title: Affiliation/Institution (include City / Country): Office Address: Telephone No., starting with a country code: (+ )- E-mail address: Relationship to applicant: 2. Name: Position/Title: Affiliation/Institution (include City / Country): Office Address: Telephone No., starting with a country code: (+ )- E-mail address: Relationship to applicant: Page 3 of 5 SECTION 6: FINANCIAL DECLARATION If admission is granted, how do you plan to cover the tuition fees and living expenses for two years in Japan (approximately 72,000 USD)? Personal resources/income: USD Support from individual donor(s) (including family or guardian): USD Support from sponsor (government / sponsoring agency / company) Awarded* Applying - Result to be notified by (Date: dd/mm/yyyy): *Please submit a photocopy of a letter from your sponsor, which shows the amount and period of funding. Name of Sponsor: Award amount: USD Other resources: Please specify in detail: Amount: USD Total financial resources: USD SECTION 7: SCHOLARSHIP Scholarship available at UNU-ISP: The Japan Foundation for UNU (JFUNU) Scholarship is available for outstanding applicants from developing countries who can demonstrate a need for financial assistance, and they will be considered as candidates for the award of the scholarship. Please note that the JFUNU scholarship is extremely competitive and offered to a very small number of students who are granted admission to UNU-ISP. Thus, applicants are strongly encouraged to apply for other funding opportunities from the government of their country, private foundations, or international funding agencies. 1. Do you want to be considered for a JFUNU Scholarship? Yes No / I am not eligible 2. If so, would you be able to fund your studies and living in Tokyo for 2 years if JFUNU Scholarship is not granted? Yes No SECTION 8: PLEASE PROVIDE THE FOLLOWING INFORMATION. 1. Have you ever been arrested, indicted, or summoned into court as a defendant in criminal proceedings, or convicted, fined or imprisoned for the violation of any law (excluding minor traffic violations)? Yes No If “yes”, please provide a statement as to the full particulars of each case and attach it in a sealed envelope marked “confidential”. 2. [For non-Japanese only] Previous Stays in Japan Date (dd/mm/yyyy) Purpose From To Page 4 of 5 3. How did you find out about UNU-ISP master’s programme? Please check all that apply. UNU-ISP website UNU website (For Japanese speakers only) 大学院情報サイト「大学院へ行こう！」 Other website: URL University (Name, include City / Country): Friend / Family UNU-ISP brochure Other: 4. Checklist of documents to be enclosed: 1. Application Form (this form) with photo and signature (all 5 pages to be completed in English) 2. Three essays (using the provided form, in English) 3. Two letters of reference (in sealed and signed envelopes) 4. Official transcript(s) of academic records for all university study to date (original or certified copy only) 5. Proof of Graduation (or Expected Graduation) Date 6. Proof of English language proficiency: TOEFL / IELTS I am exempt from submitting proof of English language proficiency for the reason 1 /2 /3 indicated on page 4 of Application Guide. I have arranged for the official scores to be sent directly to UNU-ISP from the testing institution. Date when this arrangement was made (dd/mm/yyyy): I hereby declare that all information provided is true and correct, that the submitted documents contain no forgeries, and that the essays are entirely my own work. If my application is accepted, I agree to comply with the rules and regulations of the United Nations University. If any falsifications or forgeries are discovered before or after enrolment, I understand that my acceptance may be revoked, and that no appeals will be allowed under any circumstances. Signature of Applicant: Date (dd/mm/yyyy): Applications must be submitted to the address below BY POST no later than 29 February 2012. Please note that we do not accept any online or email applications. Admissions Office Master’s Degree Programme United Nations University - Institute for Sustainability and Peace (UNU-ISP) 53-70, Jingumae 5-chome Shibuya-ku, Tokyo 150-8925 JAPAN Page 5 of 5