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1 file://c:\docume~1\admini~1\locals~1\temp\v6dfcato.htm Page 1 of 1 19/11/2552 Login: (fro) Quota in Mailbox : 358.7MB Limit MB (24.5%) 24.5% 100% ว นท : Wed 18 Nov :20: จาก: "Akane YOSHIDA (KIT)" ถ ง: ช อเร อง: Student Exchange Program AY 2010 (From KIT) ส วน ประกอบ: 2 Query on Exchange Program AY2010.pdf application/pdf KB 3 Application Form_KIT.pdf application/pdf KB Dear exchange program counterparts Greetings from Kyoto! Thank you for your devoted assistance for our student exchange program. I am Ms. Akane Yoshida of KIT International Affairs and today I am writing to inform you of our schedule for student exchange in AY Please find attached file for details. Should you have any questions or concerns please feel free to contact me. Sincerely yours Akane Yoshida(Ms.) STUDENT EXCHANGE SERVICES INTERNATIONAL AFFIRS KYOTO INSTITUTE OF TECHNOLOGY address: Matsugasaki Sakyo-ku Kyoto JAPAN Tel: Fax:

2 To exchange program counterparts in KIT partner institutions; Re: Short-Term Exchange Program AY 2010 Greetings from Kyoto Institute of Technology. I would like to express our sincere appreciation for your kind support of our exchange program. Today I am writing to inform you of minor changes in our application form. Attached to this letter please find the instruction concerning applicant names. This was added to Form A. The purpose of this change is to assist us with registering student names accurately. Thank you in advance for your understanding. Furthermore if you are planning to send your students to KIT as exchange students during the 2010 Japanese Academic Year (from April 2010 to March 2011) please contact the coordinator of KIT to let him/her know the number of students the expected length of stay and when and how long they want to come. It would be appreciated if you could provide us with this information no later than December 1st Also please note the application deadlines below: -For admission in April 2010 (Spring semester): Application for Admission: must reach us no later than December 11th For admission in October 2010 (Fall semester): Application for Admission: must reach us no later than June 18th 2010 If you would like to send your students in any other month please note that the deadline for applications is 3 months prior the admission date. Accommodations cannot be guaranteed for applications submitted after the dates indicated above. Application forms are available on our website at: For exchange program details please contact the KIT exchange program coordinator or KIT International Affairs. Contact: Student Exchange Services International Affairs Kyoto Institute of Technology

3 Application forms for Short-term Exchange Program at KYOTO INSTITUTE OF TECHNOLOGY Application materials should be sent in a single package containing all the following documents: 1. Application for Admission (Form A) (Completed in clear block letters. A passport photo should be pasted on the first page.) 2. Questionnaire for Application for Certificate of Eligibility (Form B) 3. Application for KIT International House (Marikouji Kaikan) (Form C) (If applicant desire to live in a dormitory for international students please submit this application. Admission will be decided based on room availability.) 4. Recommendation Letter (Form D) (Must be signed by the dean or the head of department in which the exchange student is currently enrolled.) 5. Recommendation Letter (Free Form) (Preferably from a professor or professional person who can verify the applicant s suitability and motivation for enrolling in KIT.) 6. Health Questionnaire (Form E) 7. Academic Transcript 8. Certificate of Enrollment (which certifies that the applicant is registered as a regular student at home institution.) 9. Photocopy of Passport (Personal details page. If unavailable at the time of application submit reason and predicted date of submission.) copies of the same ID photo (Width 3cm x height 4cm. Front view no hat upper half of body plain background. Photos are must be of high quality.) Should you have any questions or concerns please do not hesitate to contact us. Contact: Student Exchange Services International Affairs Kyoto Institute of Technology Matsugasaki Sakyo-ku Kyoto JAPAN TEL: FAX:

4 INSTRUCTIONS: 1) Type or write in Roman block letters. 2) Write numbers in Arabic numerals. 3) Write years in the Anno Domini system. 4) Do not abbreviate proper nouns. 1 Kyoto Institute of Technology Application for Admission in full in native script (same as in your passport) (Family name) (First name) (All other names) in full in Roman block letters (same as in your passport) (Form A) (Family name) (First name) (All other names) in Chinese characters if applicable Note: Your name will be officially registered as written above. Spell it exactly as it appears in your passport. KIT follows ward office policy on Chinese character-use in registration. If you are from a country where Chinese characters are in official use the official KIT registration of your name will use these characters. 2 Nationality 3. Date of birth 4. Sex Male Female / / Age Day Month Year 5 Present status at home institution: i) of the home institution and department ii) academic program enrolled and school year (at the time of application) (Check one) Undergraduate Program Date of Enrollment: Master s Program Doctoral Program year Date of expected graduation: iii) Major 6 Present address and phone number Paste your photo here. -Write your name on the back of it. -Must be taken within the past 6 months. -Size 4 x 3 cm. Phone: 7 Permanent address and phone number Phone: 8. address (An address that can be used before you come to Japan during your stay in Japan and after you return home is preferred.)

5 9 Person to be notified in applicant s home country in case of emergency i) in full (underline family name): ii) Address and phone number: iii) Occupation: iv) Relation to applicant 10. Educational background: Primary Education and Address of School Location Year and Month of Entrance and Completion From To Period of schooling Qualification Years and months Lower Secondary Education Location From To Years and months Upper Secondary Education Location From To Years and months Higher Education (Undergraduate level) Location From To Years and months Higher Education (Graduate level) Location From To Years and months Years Total years of education and months Notes: 1. Do not include kindergarten or nursery school education. 2. Include extra-curricular activities and additional university preparatory schooling under secondary education. 3. Where applicant has passed a qualifying examination for admission to a university explain in the space marked *. 4. If you require additional space you may attach separate sheets. When attaching separate sheets you must put your full name and nationality on each sheet.

6 11. Employment Record: Begin with the most recent employment if applicable. and Address of Organization Period of Employment from to from to Position Type of Work 12Language proficiency: Circle a proficiency level. (Key to proficiency levels: 4 Excellent 3 Good 2 Fair 1 Poor) Reading Writing Speaking Listening Japanese English Other languages studied and/or spoken I hereby apply for Kyoto Institute of Technology (KIT) as an Exchange Student based on the agreement between my home institution and KIT and pledge to observe the following articles while I study at KIT: (i) To refrain from violating any of the regulations of KIT and to do my best in my studies in order to achieve the aims of the exchange program; (ii) To accept responsibility for payment of any debts I may incur in Japan. Date of application: Applicant's signature: Applicant's name in Roman block letters: Recommendation of Coordinator of Exchange Program Signature Date

7 Questionnaire for Application for Certificate of Eligibility (Form B) Issue of a Certificate of Eligibility mandatory to a Japanese visa requires completion of the following questionnaire. False misleading incorrect or incomplete information will result in unfavorable treatment at the Immigration Bureau in Japan. 1. Family name Given names in Chinese character if applicable: 2. Nationality 3. Sex Male Female 4. Date of Birth 5. Place of Birth Year Month Day 6. Marital Status Married Single 7. Current town/city of residence 8. Passport No. Date of expiration Year Month Day 9. Accompanying persons if any Yes No 10. Place applying for Japanese visa (city in your country) 11. Past entry into/ stay in Japan Yes time(s) (Most recent stay in Japan: from to ) 12. Criminal record (in Japan or overseas) Yes (Details: No ) No 13. Family in Japan (Father Mother Spouse Son Daughter Brother Sister or others) and/or any co-residents Relationship Date of birth Nationality Residing with applicant or not Place of employme nt / school Status of residence 14. Total period of education (from elementary school to last institution of education) 15. Date of expected graduation (from your home institution) Year Month Day 16. Method of financial support while in Japan A. Average anticipated monthly support and method of payment (circle if applicable) (1) Money you bring with you: yen (2) Money which will be sent from abroad: yen (3) Money which someone brings you from abroad: yen (4) Money from guarantor in Japan supports you: yen (5) Scholarship: yen (6) Other: yen Organization providing scholarship: Foreign government Regional body I hereby declare that the information given above is true and correct. Japanese government Public corporation Other ( ) B. Benefactor (If you circled (2) (3) or (4) in answer to above question who supports you financially?) : Address: Occupation ( of employer): Annual income: yen Relationship to applicant: Phone: Phone: years Signature of applicant Date

8 Form INTERNATIONAL HOUSE KYOTO INSTITUTE OF TECHNOLOGY To: The Director International House Kyoto Institute of Technology APPLICATION FOR ADMISSION Signature of Applicant (Form C) Exchange Student Date: year month day In accordance with the Regulations of International House Kyoto Institute of Technology I hereby apply for the admission to the House Male of Applicant S e x Female Date of Birth year month day Nationality Occupation and Position Home Address TEL University Institution Department and Status in Japan Kyoto Institute of Technology Type of Room desired single researcher couple researcher family researcher single student couple student family student Period of stay at KIT From year month day through year month day Period desired at From year month day through year month day International House Accompanying Family Date of birth Sex Family relationship Occupation

9 (Form C) Exchange Student Form To: The Director International House Kyoto Institute of Technology PLEDGE Date: year month day Signature Since I and my family am are admitted to stay at International House Kyoto Institute of Technology I and my family hereby pledge to observe faithfully the Rules and Regulations of the House

10 To: The Director International House Kyoto Institute of Technology LETTER OF GUARANTEE Guarantor's Address (Form C) Exchange Student Date: year month day I hereby assume all responsibility for name of resident in the case of any default of financial obligations caused by his/her accident or disease concerning the rent the compensation for any loss or damage to the facilities equipment furnishings or other items provided hereinafter referred to as facilities and the cost of restoring the facilities to their original condition attributed to the above mentioned or his/her family at International House Kyoto Institute of Technology

11 Kyoto Institute of Technology Recommendation Letter Form D To the President of Kyoto Institute of Technology I hereby recommend as a candidate of the student exchange program between our institution and KIT. I certify that his/her academic capability financial status health and conduct are more than adequate for the successful completion of this program. Date / / Institution Title (B lo c k L etters ) Signature

12 Kyoto Institute of Technology HEALTH QUESTIONNAIRE Form E NOTE: All information offered below will be kept confidential and will not affect our admission decision in any way. (This information is collected and filed with your admission application but is not examined until your admission is finalized.) 1. Clinical history: Circle the diseases below which you have contracted and where applicable fill in the approximate age you were when diagnosed. a. Tuberculosis ( 結 核 性 疾 患 ) Age: ( ) b. Asthma ( 気 管 支 喘 息 ) Age: ( ) c. Heart disease ( 心 疾 患 ) Age: ( ) d. Other ( ) Age: ( ) Please give details of any illness injury or operation you have had over the past three years. (use opposite side if necessary) 2. Present status: Do you have the physical and mental stamina necessary to complete this exchange program? ( YES. / NO. ) If you answered NO please write the reasons for your concern. 3. Personal information : Sex: M F Date of birth: Nationality:

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