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表紙 【部局間】

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									                                                                                                              Program A




                KANAZAWA UNIVERSITY STUDENT EXCHANGE PROGRAM
                             (KUSEP / PROGRAM A)
                             APPLICATION PACKAGE
                                            ※ Use this sheet as a coversheet.



   Name of Applicant


   Applicant's Home Institution



      This application should be sent as complete package containing all of the following documents.


                                                      Check List

   1. Application Form for KUSEP/PROGRAM A (7 pages)                                                □

   2. Resume                                                                                        □

   3. Certificate of Health                                                                         □

   4. Certificate of Enrollment of the Applicant for Student Exchange Support Program               □
      (Scholarship for Short-Term Study in Japan)

   5. Academic Record (issued by applicant's home institution)                                      □

   6. Seven identical photographs (3.5cm×4.5cm), signed on the reverse side                         □

   7. A copy of applicant's passport (if unavailable at this time, send it as soon as possible)     □

   8. Proof of English proficiency (non-nattive English speakers only)                              □
    * Applicants are required to have sufficient English ability

   9. Agreement for Defraying Expenses with Statement of Bank Account Balance                         □
    (This requirement applies to those students who wish to participate in KUSEP if their application
      for JASSO scholarship is unsuccessful. Students applying for KUSEP should enclose a bank balance
      verifying that they have funds equivalent to 1,000,000 yen.)




This Application Package should be sent to the following address through the office responsible for student
  exchange at the applicant's home institution.




                                                        Deadline:
                                                                                                                      Program A



  INSTRUCTION

  ・Application should be written in Japanese or English.
  ・Application should be written in block letters.
  ・Numbers should be in Arabic figures.
  ・Years should be written according to the Western calendar.
  ・Proper nouns should be written in full, no abbreviations.



1.Name (in Roman alphabet, same as your passport)

                                                                                                Affix Photograph
         Family name                Given name                     Middle name               (3.5cm×4.5cm) taken
                                                                                              within last 3 months.
   2) in Chinese characters (for applicants from China or Korea)


         Family name                Given name                     Middle name


2.Nationality

3.Sex               □male                           4.Marital status             □single
                    □female                                                      □married


5.Date of birth                                                                     Age
                                  year            month              day                     <↑As of April 1, 2010>



6.Place of birth              country                          city etc.
                                                    ※in Roman alphabet and Chinese characters (if possible)


7.Present address, telephone number, fax number and e-mail address




  Address


  Tel                                                     Fax


  e-mail

8.Person to be notified in applicant's home country, in case of emergency




(1) Full name                                                     (2) Relationship to you

(3) Address, telephone number and fax number


  Address


  Tel                                                     Fax




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                                                                                                                               Program A

9.Home Institution




               Institution                      Faculty/Graduate school                            Department

                                                                                          ↓ Please circle one.
    Entrance                                        School year as of April 1, 2010 [ 1st / 2nd / 3rd / 4th ] year of
                     year            month                                            [ undergraduate / Master] program

                                               School year as of October 1, 2010 [ 1st / 2nd / 3rd / 4th ] year of
                                                                               [ undergraduate / Master] program


10.Major field(s) of study

11.Language proficiency
   Evaluate your level and mark "〇" where appropriate.


  Language                   Excellent       Good      Fair        Poor
  English
  Japanese                                                                       Your native language
  Others



  (1) Proficiency in English
  ※If you are not a native speaker of English, please fill in.

  ① Have you previously studied English ?

      □ No  □ Yes⇒ Total of                                            year(s)
                                                                       year(s) at degree level

  ② If you are not a native speaker of English, please provide the score of the English proficiency test that you have taken
   most recently, such as TOEFL, TOEIC, IELTS, or similar tests.


      Name of test                                                                   Score(s)


     ◆ If you have not taken such tests, it is preferable to submit a document which certifies your ability
      to understand lectures in English. (signed by a English teacher, person in charge of student exchange, etc.)


  (2) Proficiency in Japanese

  ① Have you previously studied Japanese ?

       □ No          □ Yes ⇒ Total of                                  year(s)

                                                                       year(s) at degree level

  ② If yes, please fill in below.
   Name of school (s) you have studied Japanese Period of study                            Textbook(s)




  ③ If you have passed the Japanese Language Proficiency Test, please circle the level that you hold.
      ⇒ Level  1 / 2 / 3 / 4




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                                                                                                              Program A



12.Period of study

            from     October 2010 to          August 2011
            ※If you would like to continue your study (research) at Kanazawa University in September
             2011, you should contact the Student Affairs Division by e-mail for details.
              (E-mail: st-exch@adm.kanazawa-u.ac.jp )


13.JASSO Scholarship


    Applicants having the nationality of a country that has diplomatic relations with Japan can apply for
   the JASSO scholarship. It is not allowed to apply for JASSO scholarship and any of Japanese Government
  (Monbukagakusho) scholarship programs (through universities or Japan Embassy) at the same time.
   If you have applied or intend to apply for Japanese Government (Monbukagakusho) scholarship for 2010,
   please do not apply for the JASSO here.


   At this moment the amount of the monthly stipend (and relocation allowancee) for JASSO scholarship 2010
   has not been determined.
  (1) Monthly stipend of 80,000 (※as of 2009)
  (2) Relocation allowancee: 80,000 yen (※as of 2009)
     (upon arrival only )
  (3) The scholarship is offered for a period of your study at Kanazawa University.
      This period cannot be changed nor extended later.  

  ★1 Do you apply for the JASSO scholarship?
    □Yes.                    □No. I do not apply for the JASSO scholarship.

  → If "Yes", please answer ★2.
  ★2 Will you take part in KUSEP even if you are not selected to receive the JASSO scholarship?

   □Yes. I will participate in the program at my own expense if I fail to be selected for the scholarship.

   □No. I will not participate in the program without the scholarship.
  Applicants circling "Yes" are required to attach a "Agreement for Defraying Expenses" with Statement
  of Bank Account Balance to their application (see KUSEP Application Checklist for more details).

  * Please be advised that Kanazawa University does not have any other scholarship programs for
    exchange students and that the minimum amount of living cost here in Kanazawa would be 80,000 yen
    per month. Therefore, if you participate in the program without the scholarship, we would like you
    to make sure that you will be able to afford necessary costs for your stay in Japan.


※ Your answer to question ★2 does not affect the selection of scholarship recipients.
+ If you check "Yes", there is a possibility that you are accepted to the program (without the scholarship)
 even if you are not selected as a scholarship recipient.
+ If you check "No", you will not be accepted to the program, unless you are selected to receive
 the scholarship.




                                                         4/7
                                                                               Program A


14. Course Plan
  Please check the courses you wish to take.


  (1) Fall Semester 2010
             ■Japanese (←Compulsory!)
             □Japanese Ways of Thinking and Japanese Culture
             □Comparing Cultures (Discussion Class)
             □Comparative Politics
             □Issues in Japanese Politics and Diplomacy
             □Experiences in Japanese Culture
             □Budô Ⅰ

  (2) Spring Semester 2011
             ■Japanese (←Compulsory!)
             □Seminar Class: Contemporary Japanese Literature in Translation
             □An Introduction to the Modern Japanese Culture and Society
             □Japan in Anthropology
             □Cultural Anthropology
             □Environmental Discourse and Literature
             □Language and Culture of Japan
             □Experiences in Japanese Culture Ⅱ
             □Budô Ⅰ
             □Budô Ⅱ
             □Fluid Mechanics and Heat Transfer
             □Civil and Environmental Engineering in Japan
             □Nature of Japan - Environmental Monitoring and Preservation -
  ◎ The curriculum is subject to change.



15.Personal research program
  ※If you have a personal research program, please indicate.


  (1) Major research field(s)


  (2) An outline of applicant's research program




                                                               5/7
                                                                                                         Program A




16.An essay which supports your candidacy


 ※Please state why you wish to participate in this program, how you would benefit from it and what you
  expect of it.




                     Date of application




                     Signature of applicant



                                                     6/7
                                                                                                           Program A



                                  RECOMMENDATION
To the President of Kanazawa University
         I acknowledge the following person as an appropriate student for Kanazawa University
         Student Exchange Program (Program A), and recommend him/her as a candidate.




  Priority order                               among                    (total number of applicants
                                                                                  from your institution)
※ If your university recommends more than one student to this program, please specify priorities
  on each applicant by filling in the "Priority order"above.




Name of institution



Student's name



1.Reason for recommendation




                                                    7/7
                                                                                                                       Program A




     2.Academic Rank

                                                                                                           

     ※The following information is required in order to apply for the JASSO scholarship. Please fill in the

      applicant’s rank based on his/her overall academic performance in the department which he/she
       belongs to. If for some reason it is not possible to specify the applicant's rank, please explain the reason.




                                           rank (the Xth)               (total number of students in the department)

    Academic rank in the department
                                                                 among




      ※ Reason(s) for not being able to specify the applicant's rank:




    Date(記入年月日)             20       .          .           Signature
                                 year/ month/ day



    Name(氏名)




    Title or Position

※ "RECOMMENDATION"form should be filled in by an authorized person affiliated to the applicant's home institution.




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