Adress：Thailand 10th Fl. Serm-Mit Tower , 159 Sukhumvit 21 Rd., Bangkok 10110 THAILAND

Vietnam Ho Chi Minh City University of Technology(HUTECH)475A , Dien Bien Phu Street , Ward 25 ,

by march 31st 2015.

※Permanent Japanese residence cannot apply.

Binh Thanh District , HCMC (Main campus)

44

Thailand ： Vietnam ：

10,000 THB6,000,000 VND

Examination for japanese university admission for international student (EJU) specified subjectJapan &The World

orJapan & The World

※Those who have N1 or N2 (JLPT) are exempt from taking the EJU test for Japanese.

※The examnation will be offered in either Japanese or English.

※Only test results from 2014 are applicable.

Academic Year 2015

APPLICATION FOR ADMISSION TOFUKUI UNIVERSITY OF TECHNOLOGY

This form must be completed by the applicant.1. Please use a black pen to fill out this form.2. Please hand in the examination card photo card together with this form.※＝Leave this space blank.

Desired Field of StudyCollege

DepartmentApplicant No.

Examinationplace

Thailand

Full Name

One’s old school

Nationality

Date of Birth

Status of Residence

Home Address

Present Address(該当者のみ)

Examination forJapanese UniversityAdmission for

International Students

Application Number

Date of Exam year month

E-mail address

Phone

Phone

PassportResidence card

orVisa

Number

Date of lssue

Number

Expirationdate

Age

Marital Status

Sex Male ・ Female

Married ・ Single

(as it appears on your passport)

year month date

※

Vietnam

1. From waist up, no

head covering

2. Taken within the last

3 months

3. H 4.5 cm x W 3.5 cm

(passport size)

4. Write your name on

the back of the photo

and paste it firmly on

this space

Notes :

1. Do not fill in spaces marked by the asterisk ( ※)

2. Please bring this ticket with you on the day of

the examination and keep it on your desk during

the written examination.

Examination Admission Ticket

Photograph

Do not cut or separate

Do not cut or separate

Examinee

Number

Name

Examination

Date

※ University stamp

Photo Card

※ Thailand

January 28, 2015 (wed.) from 1:00 p.m.

Vietnam

January 29, 2015 (thu.) from 1:00 p.m.

Examinee

Number

Name

Thailand

Vietnam

※

Location for

Academic Year 2015

Fukui University of Technology faculty of Engineering

Academic Year 2015

Fukui University of Technology faculty of Engineering

Offshore Entrance Examination for Privately Financed International Students

Academic Year 2015

Fukui University of Technology faculty of Engineering

Desired Field

of Study

College

Department

Desired Field

of Study

College

Department

Offshore Entrance Examination for Privately Financed International Students

Offshore Entrance Examination for Privately Financed International Students

※Please circle one “Thailand” or “Vietnam”

※Please circle one “Thailand” or “Vietnam”

Resume

■Educational Background

■Educational Background in Japan (Japanese Language School, Vocational School and Others)

List, in chronological order, all the schools you attended (including primary school).

Full Name Must be filled out by the applicant.

Name of SchoolDate of Entrance

years

years

years

years

year

year

year

year

month

month

month

month

year

year

year

year

month

month

month

month

years

years

year

year

month

month

year

year

month

month

year

year

month

month

year

year

month

month

Date of Graduation

Date of Entrance Date of Graduation

Term of StudyAddress of School

Name of SchoolTerm of Study

Address of School

■Employment History

I hereby declare that the above statement is true and correct.

Name of Employer

～

～

Period of EmploymentAddress of Employer

Signature of ApplicantDate(year / month / day)

Academic Year 2015Applicant No.※＝Leave this space blank.※

Below are mr reasons for becoming the financial guarantor of the student mentioned above and the means of financial support the student will receive upon his/her application to Fukui University of Technology.

Applicant’s Full Name

Date of Birth year month day

year month day

year month day

Sex M F・

Nationality

1. Reasons for becoming a financial guarantor (Please give a detailed account of your relationship with the applicant and reasons for your decision to become a financial guarantor).

I, ______________________ , certify that I will pay for the expenses incurred during the stay of the applicant in Japan.In addition, when the above applies for the renewal of his/her visa, I will submit the documents which certify mypayment for his/her expenses. The documents may be a remittance certificate, or a copy of the applicant’s bankaccount (in which evidence of remittance or expense payment is given).

2. Details

( 1 ) Tuition Yearly yen

( 2 ) Living Expenses Monthly yen

( 3 ) Means of Financial Support (Please write in detail the method of financial support: remittance/deposits)

Name of Financial Sponsor: Nationality:

Present Address: Telephone:

Place of Work: Telephone:

Occupation

Relationship to the Applicant:

Date: Signature:

Date of Birth:

Expenses Payment

Account

Academic Year 2015Applicant No.※＝Leave this space blank.※