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A1lgust 3 2017

To whom it may concern

Tatsuo Sato

Director Center for Global Education

Ibaraki University

Call for Applications to Ibaraki University Exchange Program for 2018

We are pleased to announce that Ibaraki University is inviting applications for the

2018 Ibaraki University Exchange Program WeX accepting a Ifew full-time

undergraduate andor graduate students from your institution undr the student

exchange agreement between Ibaraki University---and your institution

If there are any students at your university who are interested in studying at Ibaraki

University please recommend them to apply to the program The comple~ed application

form with other necessary documents indicated in 6 (1) below must be arrived by the

due date as specified in 6 (2)

The details are as follows

1 The number of students to be accepted

Not to exceed the number specified in the agreement

(We will adapt it considering the number of students currently being accepted by

Ibaraki University)

2 Eligibility

Applicants must be full-time undergraduategraduate students at your institution

(1) Students who demonstrate academic excellence and personal inte~rity (2) Students who do not intend to seek a degree at Ibaraki universil l

(3) Students who have a definite purpose and plan of study abroad d are expected

to obtain benefits through studying in Japan I (4) Students who while studying at Ibaraki University continue to e registered as

a full-time student at your university and shall return to your university to

continue their studies or to graduate from your university as soon as they

complete the period of studying at Ibaraki University

3 Period of stay

One academic year or less

Hst semester April 1st to the middle of August

2nd semester September 21st to 4th week of February

4 Status of student

Accepted students will have the status of a Special Auditor

5 Students arrival date in Japan

Students must arrive in Japan at the beginning of April 2018 or at the September

21st 2018

6 Recommendation of applicants

Fill in Recommendation of the Applicants (Form 1) and submit it to the Student

Exchange Division Ibaraki University along with the following docu~ents as listed

in (1) by the due date I middotPlease do not recommend more applicants than specified by the ag jeement

middotAll the documents must be written in either Japanese or English Any document I

in a language other than Japanese or English must be accompanied with a

translation into Japanese or English

middotAll documents must be completely filled in with block letters

middot Incomplete or overdue documents cannot be processed

middotAll the documents submitted will not be returned

middot During the process additional documents may be required otl er than those

hereinafter defined

middotWe will not accept applications directly sent by applicants We will not answer any

questions directly asked by the applicants

(1) Application documents

1 Applicat ion Form for the Exchange Program (Form 2) - 1 copy

2 Certificate of Enrollment of the Applicant for the Exchange Program (Form 3)

-1 copy

3 Study plan in Japan (Form 4) -1 copy

4 Certificate of Academic Record -1 copy

5 Photocopy of Passport -1 copy (if available)

6 Photograph 3 X 4cm 12 X 15 inch - 3 copies

Refer to page II

7 Certificate of Physical Examination -1 copy

8 Application for Certificate of Eligibility -1 copy

9 Certificate of annual income or bank statement for a bank account balance

11origin~l a) Certificate of annual Income of the supporter A studei t financially

supported by someone

If the supporter doesnt have a job submit hisher bank account balance

instead ofthe certificate of annual income I b) Certificate of bank account balance of the student A student pays hisher

expenses I c) Submit the respective certificates A student corresponds to bqth a) and b)

I The amount of the bank account balance should be approximately more than

60000 yen times months of stay in Japan

10 A letter of financial support 1 original

The letter certificating that financial supporter is paying all of he applicants

expenses while the applicant is studying at Ibaraki University

11 Personal History 1 copy

As for 8 10 and 11 use the designated forms attached

(2) Deadline

Period(D(For those who wish to study in Japan from April 2018 t

August 2018) October 6th 2017

Period reg (For those who wish to study in Japan from April 2018 to

February2019) October 6th 2017 I Period(For those who wish to study in Japan from Septemb r 21st 2018 to

February2019) February 28th 2018

Period(For those who wish to study in Japan from September 21st 2018 to

August2019) February 28t h 2018

7 Ibaraki University International Exchange Project Scholarship

The applicant must be a student from partner institutions under the student

exchange agreement with Ibaraki University After examining submitted documents

middot e

the recipient of the scholarship will be announced As special measures the

scholarship may be offered preferentially to a student from a partner institution

where imbalance in the number of accepted students is found

Students who are receiving scholarships (except for loans) more than 5~000 JPY per

month however are not eligible for this scholarship We will later Jtotify partner

universities of the possibility that this scholarship can be granted to thJir students

Monthly stipend yen40000 (up to 10 months) This is Only for Perio~

8 Tuition fees etc

Fees are quoted based on the exchange agreement

If the agreement includes the tuition waiver the examination fee the enrollment fee

and the tuition will be exempted I If the agreement does not include the tuition waiver students must pay the following

tuition fee I Fees for official examination Enrollment fee Tuition fee

Special Auditor ----shy -----shy yen l4800~per unit)

Students are required to enroll in a minimum of seven 90-minute classes per week

9 Living expenses

Average living expenses for international students at Ibaraki Univezisity are within

the range of yen50000 to yen100000 per month (The exact amount If the expenses

varies depending on ones choice of housing etc)

10 Health insurance

Exchange students must subscribe to the National Health Insurancer It costs about

2000 yen per month Upon joining the National H ealth Insurance System a National I

Health Insurance Certificate will be issued If she shows this to a medical institution

at the time of receiving medical treatment she will need to pay okly 30 of the

incurred medical cost I Additionally they are required to purchase the Personal Accident Insurance for

Students Pursuing Education and Research (PAISPER) However the range of

activities covered under PAISPER is limited Therefore we recommend that exchange

students buy an insurance for study abroad with a broader coverage j

See further in details Per sonal Accident Insurance for Students Pursuing Education

and Research httpjeesorjpgakkensaiJindexhtm

11 Housing

Exchange students are given priority for living in a university dormitory If no room is

available applicants will need to rent a private apartment near the campus (monthly

rent costs mostly within the range of yen 30000 to yen 35000)

12 Notification ofthe results of applications

The applicants who wish to arrive in Japan in April will receive the results of the

final selection by Ibaraki University between the middle of February and the I

beginning of March Those who wish to arrive in Japan in October 4ill receive the

results in the end of August Note that in some cases Ibaraki University may not be

able to accept all of the applicants

13 Student visa

Once their eligibilities have been confirmed we will send you Ietters of acceptance

and the document issued by the Japanese Immigration called a Certificate of

Eligibility both of which are needed to apply for a student visa

A Guide to Japanese Visas (The Ministry of Foreign Affairs ofJapan)

Japanese httpwwwmofagojpmofajtokovisaindexhtml

English httpwwwmofagojpLinfovisitvisaindexhtml

14 Inquiries

Ifyou have any questions please contact us either by email or fax eit er in Japanese

or English Please put your university name - Ibaraki Exchange on the title line in

your emailfax

We will not accept applications directly sent by applicants We will not answer any

questions directly asked by the applicants

Hiroshi Yasuda

International Exchange Division Ibaraki University

21-1 Bunkyo Mito Ibarakiken 310-8512 Japan

Telephone +81-29-228-8056 Fax +81-29-228-8594

E-mailhiroshiyasudahrvcibarakiacjp

6 (1) 6 photograph

(unit millimeter)

40

so

1 The photograph of only an applicant

2 The size of the photograph is fixed as above The size of head is from top of the

headtincluding hair) to the chin

3 Turn to the front with bare head

4 No background or shadow

5 A clear photograph

6 Has to be taken within three months

Write your nationality name and the date of your birth

Useful information

Ibaraki University

httpwww ibaraki ac jpgeneral infoindex html

International Student Center

httpwwwiscibarakiacmiddotlli

JASSO Student Guide to Japan

(~H) B~~3ZI~t~ rB~~7f1 riJ

httpwww jasso go jpstudy jsgtj html

~AWlr~ (2018iF9FJlB) Period Q) (For those who arrive in Japan in September 2018)

~s~Difm)EI~-Jltif~ilA~t1poundbullbull Recommendation of the Applicants

ToPresident of Ibaraki University

~5J~mtpoundhJE1dQ W~ffl~i3a-~O) cd3~) ttiiLi 0

I recommend the following applicants

First 2~

Second 3~

Third 4~

Fourth 5

Fifth

2018fF9f] 21 B Wi TO)PJT~

(f~ 1) Form 1

~fFa-~cAO)=Co Please fill in the CollegeGraduate school and Year of study at the date of September

iF JJ B Date Year Month Date

~~ Country

A+O

Nameof Institution

~ijlO

Title

JCO

Name

=EO

21st 2018

Signature I I---------------------------------~-------shyI

-yen13J t =l13 ~ren

Contact Person II- 0

name I lgtz~ijlO

t itle I I)lt -jlshy

E-mail I IlIJ-aO

Division I IXrJI

Address I isecti53 I-AX TELFAX I

I

--------------------------------- --------------

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5JrJil2~R~0)=fit (m~sectlkO)=Mi) $~~A~fFPltm 1 OJ ooisectltfltlltim1f

For applicant part 1 Ministry ofJu~tice Government of Japan

o Please fill the yellow columns a1d put tle yeo~ circles on the apprqpri~ terms 1pound ~ if ~ yenJ IE w ~ it ~ 1T Ej3 ~~ it

APPLICATION FOR CERTIFICATE OF ELIGIBILITY

A 00 ifJ1llfpj ~ To the Director General of Regional Immigration Bureau

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40mm x 30mm the certificateshowing eligibility for theconditions provided for in 7Paragraph 1 Item 2of thesaidAct Pursuant to theprovisions ofArticle7-2of theImmigration Control andRefugee Recognition Act I hereby applyfor

1 00 ~plusmnili ~ 2 jamppf S ampp f S Month DayNationalityRegion Dateofbirth Y-eear-+-__------__---==_

~- ~- I 3 ~m FAMILY NAME Given name

4 ~) JFYcl e a~rct middotiffJopa(f5 tffi~fl 6 1lc11~0)1f~ 1f ~ Sex Mal lt-female Placeofbirth Marilal status MarrleampL-BngleI

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9 S 1t3fT01lHC I It x~ll7lltprn)O~2-1-1 ~~~~~B~yenI~xjft~

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~~~ m~~~ I029-228-8056 Telephone No Ceilular phone No --------r------- shy

fj10 1~ (l )~ (2)1fWJM~amp ampp I S Passport Number Dale ofexpiration Y-ee-ear+- Month Day---__=t

11 AOOsectiyenJ (rJzO)v f1iJ~~ T0 tO) 7r~Iv_e ltt~v o) Purposeofenlry check one of Ihe followings o I r~~J 0 I r~~J 0 J r~J 0 J rX1l TsectliJiJ 0 K r~J o uyena~J

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o R r~yen1EJ 0 R rjfIETsecttb(-liJf~flt5YttJ~~)J 0 Rr~TsectYttJ(EPA~ )J Dependent Designated Activities (Dependent ofResearcheror ITengineer ofadesignated org) GesignaledAclivilies(Dependenl ofEPA)

o T rSA0)1lc11~~J 0 Tr7k1plusmn~0)IlCfl~~J 0 Tr~1plusmn~J Spouseor ChildofJapanese National Spouse orChild ofPermanent Resident long Term Resident

o riWiJtJllF~~il (1-1) J 0 r~Jt JllF~~ ( H p ) J 0 r~JtJllF~~ (l ) J ourJ(-0)1tJ Highly Skilled Professional(i)(a) Highly Skilled Pnofessional(i)(b) Highly Skilled Pnofessional(i)(c) Others

12 A OO TltEampPfj S ampp f S 13 JJ~T~ft Date ofentry Year Month Day Port ofentry

14 yen(poundTIEMF9 15 1Rl1=F~0)1f1euro 1f-~ Intended length ofstay Accompanying persons if any ytJ~ r-No

16 ~~iE$~TltEf1J Intended place toapply forvisa

17 iamp1-$0) IplusmnJ A 00 ~ fmiddot -middot ---~ Past entry into departure from Japan Ye-rJo

Cl ~ -eW~J~~tRlJ ~) (Fill inthefollowingswhen the answer is Yes)

]Jamp FII f ] miliO)IplusmnJAOO~ ampp fj ampp f S I 1 anytlme(s) The latest entry from Year Month Day to Year Monlh Day

18 ~[~7r~S3 CT0m5H~~TtCO)1f~ (S 007fflOIT0b0)7r2tlo ) Criminal record (In Japanove eas) 1f(AiiyenJfj ) QD Explain if Yes _ _________________________--- ) tJoYes (Delail

19 ill-$~~iliIJXItlplusmnJoofrJfJ01plusmnJ000)1f~ 1f 1euro Departure bydeportation departure order Yes No

Cl ~-a (fi~ ~ ~jlHR IJtA g- ) ]Jamp ] mili0)~~ ampp f S Year Month Day(Fill inthe followings when the answer [s Yes) time(s) The latest departure bydeportation

20 (pound S tll~ (x B 1lC1~T- JL~fr$JKftc) ampLfIRlfi5-~ FamilyinJapan (Father Mother Spouse Son Daughter Brother Sisterorothers)orco-residents

1poundff1tJ 1-lt -1 jamppf S 00 iiHt ~ ~g1JE iIJ~McmiddotJHj~$t 1lfjJll7llt~1fMeJHHn~m

IIndod Iea Resldance card numberNameRelationship Dale ofbirth NationalityRegion with ppicantornol Place ofemploymenUschool Special Permanent Resident Certificate numberI

Fill if any

-~e ------------------------+ ----------------------shyTfr~~-yZ ------------------------------1--- --------------------------------

YesI No Tf~~~-~oZ ----------------------------r-- -------------------------------shy

73ZJflX~5OOA~~(plusmn$~E~~1f -Health Certificate of an International Student for Ibaraki University (for special aUditor~ (ffJJI~~~tl)

H)V (Middle) I

77~~- (Family) 77- ~ (First) 3$m address sect~~ Tzipcode

E pp 0mother riifue

r=gt JIe ~ 3ill~h--Yr

jTT~~C 0

T -j(n

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C0checl0

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)

( (corrected)

( tJ 1J

eyesight

OlEA ~ jt normpoundr

colordiscrimination 0 ~E (

~1flpound method of photographing o r~~ indirectlyDO directly

photograph number

t~~graphing IjZgX 1fshy jj

Y M

COtreatmentOobservation is necessary)

none

FJfJiO~ OpinionO~

yes

A$1~ O)fYt~1F~J a~T~ ~ mO)~~c-trP1G Express existence or nonexistence and detail of any noteworthy illness on the view ofhealth care in the university

aq I ~~I2fJT(1)~L~BC1) ~t3 tJ tsect~rchV =shy ~ ~fIEfjFjT 0 0

I attest above contents based on the results of diagnostics IjZiJX ~ jj (]

date Y M D

address 1plusmnm regtEplusmnfu) -+shy _

nameoftheinstituteorhoopital [3[ ~ r~ ~ ~ -----------+-----=name ofthe doctor andsignature or seal [3[ ~ffi 0) A ~

seal

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[NOTES] 1)Ifeyesight is not normal be sure to fill out the corrected eyesight 2) Please dont leave columns in blank In order to prevent accidental skip please fill any word

eg none

AOO~FIffiffi ~ Ib Director of Imm igrat ion Bureau

Letter of Financial Support

OOflf Nationality

~6 Name

~fF1313 Date of birth

fF Year

13 Mont h

13 Day

(~ fx) (MaleFemal e)

I 5lLdi O)t a JBcO) t O) b~ 13 OOI~ ~OO ~cmO)ffi~)[1fI~ f~ ~ i ~tO) -c rBc O) ~jO ~ ffi~ )[0)51~ sectt~t~rrt~mgFjT~ ~ ~ tl~ffi Jt)[I~-J v -C ~iEgFj ~~T o I have become a financial supporter ofthe above applicant dur ing hisher stay in J apa n and therefore I would like 0 explain the reason for support and make the following stateme nt

1 ffiJt)[ 0)5Ist~tffirrt (ffl ~1f 0) ffi )[ ~ 5 1 )t ~ttgamp affl~1f ~ 0) ~11~ -Jv _C ~yenJ 1~Bc$X L _C ltt-c ~ V 0

Re ason for support (Explain the circumstance and the re lationshi p between yourself an d th e applicant in det ail Also please sta te that you will be responsible for the financi al need) I

---------------------------------------------------------------------------------------------------------------------------------------------------- ----- -------------------------------_

--- - - ----- ------------------ - ----------------------------- - ------------------------ -------------------------- ----middot-------------------middot-------r ---------middot----middot---- -----------------_

---- ----------------------------------------------------- ------------ -- -- - ------------------------------ ------ -----------------------1------------------------------------

--__---_---_--------------------------- ---------------------------------------------------_---------------------------------__---------------- -----__------------------------------_

---------- ------------_--- ---- ----- --- - ----------------------------- ----------------------------------------------------------------- ------ ---- _--------------- -----------------_ _--_

2 gJtXiJa Content of financi al support

_ _ _ _ hereby prove that I will support the above applicant du ring hisher stay in J apan

(1) ~ m13 yen=-fF ~ 1=prlf~ P3 Tuit ion MonthlySemi a nnuallyAnnually JPY

(2) 17iHt 13 tJi Living expenses Monthly amount I~

(3) )[1f1J- (i~ middot1hRi6Jj-~ )[1fyent_~~ijsyenJI~v-C ltt-c~v o) Met hod of support (Explain method of remittance tr ansfer etc)

------- ------------------------------------- --------------------------------------------------- ------------------ --------------- ------------1------------------------------------

-----------------------------------------------------------------------------------------------------------middot------middot--------- ------r --------------------------------------- -------------------------------------------------------------------------------------------------------- ---middot------------ --middot----------middot--T----middot---------middot--middot-------------------

--------- -- ----_--------------- ------------------------------- ------------ --------------------------------------------------------------r-------middot-----middot---middot----------- --------- -shy

-------------------------------------------------------------------------------- ----------- ----- ------------- ------~~-l-------------middot~~---------~~ --

~JtX1f Supporter

1EP)f T Address

Tel E-mail

~6 (w6 ) Name (Signature)

5ft1 ~ 0) Mt Relationship to the applicant

3 Period of stay

One academic year or less

Hst semester April 1st to the middle of August

2nd semester September 21st to 4th week of February

4 Status of student

Accepted students will have the status of a Special Auditor

5 Students arrival date in Japan

Students must arrive in Japan at the beginning of April 2018 or at the September

21st 2018

6 Recommendation of applicants

Fill in Recommendation of the Applicants (Form 1) and submit it to the Student

Exchange Division Ibaraki University along with the following docu~ents as listed

in (1) by the due date I middotPlease do not recommend more applicants than specified by the ag jeement

middotAll the documents must be written in either Japanese or English Any document I

in a language other than Japanese or English must be accompanied with a

translation into Japanese or English

middotAll documents must be completely filled in with block letters

middot Incomplete or overdue documents cannot be processed

middotAll the documents submitted will not be returned

middot During the process additional documents may be required otl er than those

hereinafter defined

middotWe will not accept applications directly sent by applicants We will not answer any

questions directly asked by the applicants

(1) Application documents

1 Applicat ion Form for the Exchange Program (Form 2) - 1 copy

2 Certificate of Enrollment of the Applicant for the Exchange Program (Form 3)

-1 copy

3 Study plan in Japan (Form 4) -1 copy

4 Certificate of Academic Record -1 copy

5 Photocopy of Passport -1 copy (if available)

6 Photograph 3 X 4cm 12 X 15 inch - 3 copies

Refer to page II

7 Certificate of Physical Examination -1 copy

8 Application for Certificate of Eligibility -1 copy

9 Certificate of annual income or bank statement for a bank account balance

11origin~l a) Certificate of annual Income of the supporter A studei t financially

supported by someone

If the supporter doesnt have a job submit hisher bank account balance

instead ofthe certificate of annual income I b) Certificate of bank account balance of the student A student pays hisher

expenses I c) Submit the respective certificates A student corresponds to bqth a) and b)

I The amount of the bank account balance should be approximately more than

60000 yen times months of stay in Japan

10 A letter of financial support 1 original

The letter certificating that financial supporter is paying all of he applicants

expenses while the applicant is studying at Ibaraki University

11 Personal History 1 copy

As for 8 10 and 11 use the designated forms attached

(2) Deadline

Period(D(For those who wish to study in Japan from April 2018 t

August 2018) October 6th 2017

Period reg (For those who wish to study in Japan from April 2018 to

February2019) October 6th 2017 I Period(For those who wish to study in Japan from Septemb r 21st 2018 to

February2019) February 28th 2018

Period(For those who wish to study in Japan from September 21st 2018 to

August2019) February 28t h 2018

7 Ibaraki University International Exchange Project Scholarship

The applicant must be a student from partner institutions under the student

exchange agreement with Ibaraki University After examining submitted documents

middot e

the recipient of the scholarship will be announced As special measures the

scholarship may be offered preferentially to a student from a partner institution

where imbalance in the number of accepted students is found

Students who are receiving scholarships (except for loans) more than 5~000 JPY per

month however are not eligible for this scholarship We will later Jtotify partner

universities of the possibility that this scholarship can be granted to thJir students

Monthly stipend yen40000 (up to 10 months) This is Only for Perio~

8 Tuition fees etc

Fees are quoted based on the exchange agreement

If the agreement includes the tuition waiver the examination fee the enrollment fee

and the tuition will be exempted I If the agreement does not include the tuition waiver students must pay the following

tuition fee I Fees for official examination Enrollment fee Tuition fee

Special Auditor ----shy -----shy yen l4800~per unit)

Students are required to enroll in a minimum of seven 90-minute classes per week

9 Living expenses

Average living expenses for international students at Ibaraki Univezisity are within

the range of yen50000 to yen100000 per month (The exact amount If the expenses

varies depending on ones choice of housing etc)

10 Health insurance

Exchange students must subscribe to the National Health Insurancer It costs about

2000 yen per month Upon joining the National H ealth Insurance System a National I

Health Insurance Certificate will be issued If she shows this to a medical institution

at the time of receiving medical treatment she will need to pay okly 30 of the

incurred medical cost I Additionally they are required to purchase the Personal Accident Insurance for

Students Pursuing Education and Research (PAISPER) However the range of

activities covered under PAISPER is limited Therefore we recommend that exchange

students buy an insurance for study abroad with a broader coverage j

See further in details Per sonal Accident Insurance for Students Pursuing Education

and Research httpjeesorjpgakkensaiJindexhtm

11 Housing

Exchange students are given priority for living in a university dormitory If no room is

available applicants will need to rent a private apartment near the campus (monthly

rent costs mostly within the range of yen 30000 to yen 35000)

12 Notification ofthe results of applications

The applicants who wish to arrive in Japan in April will receive the results of the

final selection by Ibaraki University between the middle of February and the I

beginning of March Those who wish to arrive in Japan in October 4ill receive the

results in the end of August Note that in some cases Ibaraki University may not be

able to accept all of the applicants

13 Student visa

Once their eligibilities have been confirmed we will send you Ietters of acceptance

and the document issued by the Japanese Immigration called a Certificate of

Eligibility both of which are needed to apply for a student visa

A Guide to Japanese Visas (The Ministry of Foreign Affairs ofJapan)

Japanese httpwwwmofagojpmofajtokovisaindexhtml

English httpwwwmofagojpLinfovisitvisaindexhtml

14 Inquiries

Ifyou have any questions please contact us either by email or fax eit er in Japanese

or English Please put your university name - Ibaraki Exchange on the title line in

your emailfax

We will not accept applications directly sent by applicants We will not answer any

questions directly asked by the applicants

Hiroshi Yasuda

International Exchange Division Ibaraki University

21-1 Bunkyo Mito Ibarakiken 310-8512 Japan

Telephone +81-29-228-8056 Fax +81-29-228-8594

E-mailhiroshiyasudahrvcibarakiacjp

6 (1) 6 photograph

(unit millimeter)

40

so

1 The photograph of only an applicant

2 The size of the photograph is fixed as above The size of head is from top of the

headtincluding hair) to the chin

3 Turn to the front with bare head

4 No background or shadow

5 A clear photograph

6 Has to be taken within three months

Write your nationality name and the date of your birth

Useful information

Ibaraki University

httpwww ibaraki ac jpgeneral infoindex html

International Student Center

httpwwwiscibarakiacmiddotlli

JASSO Student Guide to Japan

(~H) B~~3ZI~t~ rB~~7f1 riJ

httpwww jasso go jpstudy jsgtj html

~AWlr~ (2018iF9FJlB) Period Q) (For those who arrive in Japan in September 2018)

~s~Difm)EI~-Jltif~ilA~t1poundbullbull Recommendation of the Applicants

ToPresident of Ibaraki University

~5J~mtpoundhJE1dQ W~ffl~i3a-~O) cd3~) ttiiLi 0

I recommend the following applicants

First 2~

Second 3~

Third 4~

Fourth 5

Fifth

2018fF9f] 21 B Wi TO)PJT~

(f~ 1) Form 1

~fFa-~cAO)=Co Please fill in the CollegeGraduate school and Year of study at the date of September

iF JJ B Date Year Month Date

~~ Country

A+O

Nameof Institution

~ijlO

Title

JCO

Name

=EO

21st 2018

Signature I I---------------------------------~-------shyI

-yen13J t =l13 ~ren

Contact Person II- 0

name I lgtz~ijlO

t itle I I)lt -jlshy

E-mail I IlIJ-aO

Division I IXrJI

Address I isecti53 I-AX TELFAX I

I

--------------------------------- --------------

------------- -------------

5JrJil2~R~0)=fit (m~sectlkO)=Mi) $~~A~fFPltm 1 OJ ooisectltfltlltim1f

For applicant part 1 Ministry ofJu~tice Government of Japan

o Please fill the yellow columns a1d put tle yeo~ circles on the apprqpri~ terms 1pound ~ if ~ yenJ IE w ~ it ~ 1T Ej3 ~~ it

APPLICATION FOR CERTIFICATE OF ELIGIBILITY

A 00 ifJ1llfpj ~ To the Director General of Regional Immigration Bureau

PhotoIplusmnJAooif~ampLf~~~~$ gfn~0)20)m~~Irj~ rJzO)ct3~PJ$~7sectk~1Ji~21 mlf0 ~1tf1~g-l- -Cv 0 sectjO)WE~if0)~1t7r$~~l-To

40mm x 30mm the certificateshowing eligibility for theconditions provided for in 7Paragraph 1 Item 2of thesaidAct Pursuant to theprovisions ofArticle7-2of theImmigration Control andRefugee Recognition Act I hereby applyfor

1 00 ~plusmnili ~ 2 jamppf S ampp f S Month DayNationalityRegion Dateofbirth Y-eear-+-__------__---==_

~- ~- I 3 ~m FAMILY NAME Given name

4 ~) JFYcl e a~rct middotiffJopa(f5 tffi~fl 6 1lc11~0)1f~ 1f ~ Sex Mal lt-female Placeofbirth Marilal status MarrleampL-BngleI

7 ~ ~ 8 00~t3IT0fi5-1plusmnL1l Occupation Home towncity

9 S 1t3fT01lHC I It x~ll7lltprn)O~2-1-1 ~~~~~B~yenI~xjft~

AddressinJapan

~~~ m~~~ I029-228-8056 Telephone No Ceilular phone No --------r------- shy

fj10 1~ (l )~ (2)1fWJM~amp ampp I S Passport Number Dale ofexpiration Y-ee-ear+- Month Day---__=t

11 AOOsectiyenJ (rJzO)v f1iJ~~ T0 tO) 7r~Iv_e ltt~v o) Purposeofenlry check one of Ihe followings o I r~~J 0 I r~~J 0 J r~J 0 J rX1l TsectliJiJ 0 K r~J o uyena~J

Professor Instructor Artist CulturalActivities Religious ActivIties Joumalist

o L rJ1~fjiyeniibJ 0 M r~B ~~J 0 L r-liJf~ (iyenilUJ) J lntra-company Transferee Business Manager Researcher (Transferee)

o N r-liJf~J 0 N rj1V1~ AXP~middot oo~~rJ 0 N rj1filSJ Researcher Engineer SpecialistinHumanities international Services Skilled l abor

o Nr~flt5WJ(-liJf~Tsecttb ~)J 0 0 rJl1TJ _ p rfjj$J 0 Q r-liJfJ 0 Y rj1frtJ~1sectI (1)J Designated Aclivilles(Researcher or IT engineer of adesignated org) Entertainer Student Trainee Technicallntem Training ( i

o R r~yen1EJ 0 R rjfIETsecttb(-liJf~flt5YttJ~~)J 0 Rr~TsectYttJ(EPA~ )J Dependent Designated Activities (Dependent ofResearcheror ITengineer ofadesignated org) GesignaledAclivilies(Dependenl ofEPA)

o T rSA0)1lc11~~J 0 Tr7k1plusmn~0)IlCfl~~J 0 Tr~1plusmn~J Spouseor ChildofJapanese National Spouse orChild ofPermanent Resident long Term Resident

o riWiJtJllF~~il (1-1) J 0 r~Jt JllF~~ ( H p ) J 0 r~JtJllF~~ (l ) J ourJ(-0)1tJ Highly Skilled Professional(i)(a) Highly Skilled Pnofessional(i)(b) Highly Skilled Pnofessional(i)(c) Others

12 A OO TltEampPfj S ampp f S 13 JJ~T~ft Date ofentry Year Month Day Port ofentry

14 yen(poundTIEMF9 15 1Rl1=F~0)1f1euro 1f-~ Intended length ofstay Accompanying persons if any ytJ~ r-No

16 ~~iE$~TltEf1J Intended place toapply forvisa

17 iamp1-$0) IplusmnJ A 00 ~ fmiddot -middot ---~ Past entry into departure from Japan Ye-rJo

Cl ~ -eW~J~~tRlJ ~) (Fill inthefollowingswhen the answer is Yes)

]Jamp FII f ] miliO)IplusmnJAOO~ ampp fj ampp f S I 1 anytlme(s) The latest entry from Year Month Day to Year Monlh Day

18 ~[~7r~S3 CT0m5H~~TtCO)1f~ (S 007fflOIT0b0)7r2tlo ) Criminal record (In Japanove eas) 1f(AiiyenJfj ) QD Explain if Yes _ _________________________--- ) tJoYes (Delail

19 ill-$~~iliIJXItlplusmnJoofrJfJ01plusmnJ000)1f~ 1f 1euro Departure bydeportation departure order Yes No

Cl ~-a (fi~ ~ ~jlHR IJtA g- ) ]Jamp ] mili0)~~ ampp f S Year Month Day(Fill inthe followings when the answer [s Yes) time(s) The latest departure bydeportation

20 (pound S tll~ (x B 1lC1~T- JL~fr$JKftc) ampLfIRlfi5-~ FamilyinJapan (Father Mother Spouse Son Daughter Brother Sisterorothers)orco-residents

1poundff1tJ 1-lt -1 jamppf S 00 iiHt ~ ~g1JE iIJ~McmiddotJHj~$t 1lfjJll7llt~1fMeJHHn~m

IIndod Iea Resldance card numberNameRelationship Dale ofbirth NationalityRegion with ppicantornol Place ofemploymenUschool Special Permanent Resident Certificate numberI

Fill if any

-~e ------------------------+ ----------------------shyTfr~~-yZ ------------------------------1--- --------------------------------

YesI No Tf~~~-~oZ ----------------------------r-- -------------------------------shy

73ZJflX~5OOA~~(plusmn$~E~~1f -Health Certificate of an International Student for Ibaraki University (for special aUditor~ (ffJJI~~~tl)

H)V (Middle) I

77~~- (Family) 77- ~ (First) 3$m address sect~~ Tzipcode

E pp 0mother riifue

r=gt JIe ~ 3ill~h--Yr

jTT~~C 0

T -j(n

I female

t~amp~ y~ J ~ ~1l1fif ~)yiarsold)

C0checl0

~ 1J audition

)

( (corrected)

( tJ 1J

eyesight

OlEA ~ jt normpoundr

colordiscrimination 0 ~E (

~1flpound method of photographing o r~~ indirectlyDO directly

photograph number

t~~graphing IjZgX 1fshy jj

Y M

COtreatmentOobservation is necessary)

none

FJfJiO~ OpinionO~

yes

A$1~ O)fYt~1F~J a~T~ ~ mO)~~c-trP1G Express existence or nonexistence and detail of any noteworthy illness on the view ofhealth care in the university

aq I ~~I2fJT(1)~L~BC1) ~t3 tJ tsect~rchV =shy ~ ~fIEfjFjT 0 0

I attest above contents based on the results of diagnostics IjZiJX ~ jj (]

date Y M D

address 1plusmnm regtEplusmnfu) -+shy _

nameoftheinstituteorhoopital [3[ ~ r~ ~ ~ -----------+-----=name ofthe doctor andsignature or seal [3[ ~ffi 0) A ~

seal

[~B~o)~] I 1) tJttJ~~EiJ~(b6~~j ~fmlEtJ1J~~CA L-c lttc~ V 2) -to)1t~fl~j~nCAL Jf5tO)ftvlMl-ct~ttMicrrftL ~h1~~~~CAL ~cft~n

-cftv = c iJ ~biJ6 J 5 ~ L-c lttc~v ~ctt~w$fr mJiCplusmn L-ct G5 = c ~ft lJ jTO) -ca~L -clt tc~v o I

[NOTES] 1)Ifeyesight is not normal be sure to fill out the corrected eyesight 2) Please dont leave columns in blank In order to prevent accidental skip please fill any word

eg none

AOO~FIffiffi ~ Ib Director of Imm igrat ion Bureau

Letter of Financial Support

OOflf Nationality

~6 Name

~fF1313 Date of birth

fF Year

13 Mont h

13 Day

(~ fx) (MaleFemal e)

I 5lLdi O)t a JBcO) t O) b~ 13 OOI~ ~OO ~cmO)ffi~)[1fI~ f~ ~ i ~tO) -c rBc O) ~jO ~ ffi~ )[0)51~ sectt~t~rrt~mgFjT~ ~ ~ tl~ffi Jt)[I~-J v -C ~iEgFj ~~T o I have become a financial supporter ofthe above applicant dur ing hisher stay in J apa n and therefore I would like 0 explain the reason for support and make the following stateme nt

1 ffiJt)[ 0)5Ist~tffirrt (ffl ~1f 0) ffi )[ ~ 5 1 )t ~ttgamp affl~1f ~ 0) ~11~ -Jv _C ~yenJ 1~Bc$X L _C ltt-c ~ V 0

Re ason for support (Explain the circumstance and the re lationshi p between yourself an d th e applicant in det ail Also please sta te that you will be responsible for the financi al need) I

---------------------------------------------------------------------------------------------------------------------------------------------------- ----- -------------------------------_

--- - - ----- ------------------ - ----------------------------- - ------------------------ -------------------------- ----middot-------------------middot-------r ---------middot----middot---- -----------------_

---- ----------------------------------------------------- ------------ -- -- - ------------------------------ ------ -----------------------1------------------------------------

--__---_---_--------------------------- ---------------------------------------------------_---------------------------------__---------------- -----__------------------------------_

---------- ------------_--- ---- ----- --- - ----------------------------- ----------------------------------------------------------------- ------ ---- _--------------- -----------------_ _--_

2 gJtXiJa Content of financi al support

_ _ _ _ hereby prove that I will support the above applicant du ring hisher stay in J apan

(1) ~ m13 yen=-fF ~ 1=prlf~ P3 Tuit ion MonthlySemi a nnuallyAnnually JPY

(2) 17iHt 13 tJi Living expenses Monthly amount I~

(3) )[1f1J- (i~ middot1hRi6Jj-~ )[1fyent_~~ijsyenJI~v-C ltt-c~v o) Met hod of support (Explain method of remittance tr ansfer etc)

------- ------------------------------------- --------------------------------------------------- ------------------ --------------- ------------1------------------------------------

-----------------------------------------------------------------------------------------------------------middot------middot--------- ------r --------------------------------------- -------------------------------------------------------------------------------------------------------- ---middot------------ --middot----------middot--T----middot---------middot--middot-------------------

--------- -- ----_--------------- ------------------------------- ------------ --------------------------------------------------------------r-------middot-----middot---middot----------- --------- -shy

-------------------------------------------------------------------------------- ----------- ----- ------------- ------~~-l-------------middot~~---------~~ --

~JtX1f Supporter

1EP)f T Address

Tel E-mail

~6 (w6 ) Name (Signature)

5ft1 ~ 0) Mt Relationship to the applicant

Refer to page II

7 Certificate of Physical Examination -1 copy

8 Application for Certificate of Eligibility -1 copy

9 Certificate of annual income or bank statement for a bank account balance

11origin~l a) Certificate of annual Income of the supporter A studei t financially

supported by someone

If the supporter doesnt have a job submit hisher bank account balance

instead ofthe certificate of annual income I b) Certificate of bank account balance of the student A student pays hisher

expenses I c) Submit the respective certificates A student corresponds to bqth a) and b)

I The amount of the bank account balance should be approximately more than

60000 yen times months of stay in Japan

10 A letter of financial support 1 original

The letter certificating that financial supporter is paying all of he applicants

expenses while the applicant is studying at Ibaraki University

11 Personal History 1 copy

As for 8 10 and 11 use the designated forms attached

(2) Deadline

Period(D(For those who wish to study in Japan from April 2018 t

August 2018) October 6th 2017

Period reg (For those who wish to study in Japan from April 2018 to

February2019) October 6th 2017 I Period(For those who wish to study in Japan from Septemb r 21st 2018 to

February2019) February 28th 2018

Period(For those who wish to study in Japan from September 21st 2018 to

August2019) February 28t h 2018

7 Ibaraki University International Exchange Project Scholarship

The applicant must be a student from partner institutions under the student

exchange agreement with Ibaraki University After examining submitted documents

middot e

the recipient of the scholarship will be announced As special measures the

scholarship may be offered preferentially to a student from a partner institution

where imbalance in the number of accepted students is found

Students who are receiving scholarships (except for loans) more than 5~000 JPY per

month however are not eligible for this scholarship We will later Jtotify partner

universities of the possibility that this scholarship can be granted to thJir students

Monthly stipend yen40000 (up to 10 months) This is Only for Perio~

8 Tuition fees etc

Fees are quoted based on the exchange agreement

If the agreement includes the tuition waiver the examination fee the enrollment fee

and the tuition will be exempted I If the agreement does not include the tuition waiver students must pay the following

tuition fee I Fees for official examination Enrollment fee Tuition fee

Special Auditor ----shy -----shy yen l4800~per unit)

Students are required to enroll in a minimum of seven 90-minute classes per week

9 Living expenses

Average living expenses for international students at Ibaraki Univezisity are within

the range of yen50000 to yen100000 per month (The exact amount If the expenses

varies depending on ones choice of housing etc)

10 Health insurance

Exchange students must subscribe to the National Health Insurancer It costs about

2000 yen per month Upon joining the National H ealth Insurance System a National I

Health Insurance Certificate will be issued If she shows this to a medical institution

at the time of receiving medical treatment she will need to pay okly 30 of the

incurred medical cost I Additionally they are required to purchase the Personal Accident Insurance for

Students Pursuing Education and Research (PAISPER) However the range of

activities covered under PAISPER is limited Therefore we recommend that exchange

students buy an insurance for study abroad with a broader coverage j

See further in details Per sonal Accident Insurance for Students Pursuing Education

and Research httpjeesorjpgakkensaiJindexhtm

11 Housing

Exchange students are given priority for living in a university dormitory If no room is

available applicants will need to rent a private apartment near the campus (monthly

rent costs mostly within the range of yen 30000 to yen 35000)

12 Notification ofthe results of applications

The applicants who wish to arrive in Japan in April will receive the results of the

final selection by Ibaraki University between the middle of February and the I

beginning of March Those who wish to arrive in Japan in October 4ill receive the

results in the end of August Note that in some cases Ibaraki University may not be

able to accept all of the applicants

13 Student visa

Once their eligibilities have been confirmed we will send you Ietters of acceptance

and the document issued by the Japanese Immigration called a Certificate of

Eligibility both of which are needed to apply for a student visa

A Guide to Japanese Visas (The Ministry of Foreign Affairs ofJapan)

Japanese httpwwwmofagojpmofajtokovisaindexhtml

English httpwwwmofagojpLinfovisitvisaindexhtml

14 Inquiries

Ifyou have any questions please contact us either by email or fax eit er in Japanese

or English Please put your university name - Ibaraki Exchange on the title line in

your emailfax

We will not accept applications directly sent by applicants We will not answer any

questions directly asked by the applicants

Hiroshi Yasuda

International Exchange Division Ibaraki University

21-1 Bunkyo Mito Ibarakiken 310-8512 Japan

Telephone +81-29-228-8056 Fax +81-29-228-8594

E-mailhiroshiyasudahrvcibarakiacjp

6 (1) 6 photograph

(unit millimeter)

40

so

1 The photograph of only an applicant

2 The size of the photograph is fixed as above The size of head is from top of the

headtincluding hair) to the chin

3 Turn to the front with bare head

4 No background or shadow

5 A clear photograph

6 Has to be taken within three months

Write your nationality name and the date of your birth

Useful information

Ibaraki University

httpwww ibaraki ac jpgeneral infoindex html

International Student Center

httpwwwiscibarakiacmiddotlli

JASSO Student Guide to Japan

(~H) B~~3ZI~t~ rB~~7f1 riJ

httpwww jasso go jpstudy jsgtj html

~AWlr~ (2018iF9FJlB) Period Q) (For those who arrive in Japan in September 2018)

~s~Difm)EI~-Jltif~ilA~t1poundbullbull Recommendation of the Applicants

ToPresident of Ibaraki University

~5J~mtpoundhJE1dQ W~ffl~i3a-~O) cd3~) ttiiLi 0

I recommend the following applicants

First 2~

Second 3~

Third 4~

Fourth 5

Fifth

2018fF9f] 21 B Wi TO)PJT~

(f~ 1) Form 1

~fFa-~cAO)=Co Please fill in the CollegeGraduate school and Year of study at the date of September

iF JJ B Date Year Month Date

~~ Country

A+O

Nameof Institution

~ijlO

Title

JCO

Name

=EO

21st 2018

Signature I I---------------------------------~-------shyI

-yen13J t =l13 ~ren

Contact Person II- 0

name I lgtz~ijlO

t itle I I)lt -jlshy

E-mail I IlIJ-aO

Division I IXrJI

Address I isecti53 I-AX TELFAX I

I

--------------------------------- --------------

------------- -------------

5JrJil2~R~0)=fit (m~sectlkO)=Mi) $~~A~fFPltm 1 OJ ooisectltfltlltim1f

For applicant part 1 Ministry ofJu~tice Government of Japan

o Please fill the yellow columns a1d put tle yeo~ circles on the apprqpri~ terms 1pound ~ if ~ yenJ IE w ~ it ~ 1T Ej3 ~~ it

APPLICATION FOR CERTIFICATE OF ELIGIBILITY

A 00 ifJ1llfpj ~ To the Director General of Regional Immigration Bureau

PhotoIplusmnJAooif~ampLf~~~~$ gfn~0)20)m~~Irj~ rJzO)ct3~PJ$~7sectk~1Ji~21 mlf0 ~1tf1~g-l- -Cv 0 sectjO)WE~if0)~1t7r$~~l-To

40mm x 30mm the certificateshowing eligibility for theconditions provided for in 7Paragraph 1 Item 2of thesaidAct Pursuant to theprovisions ofArticle7-2of theImmigration Control andRefugee Recognition Act I hereby applyfor

1 00 ~plusmnili ~ 2 jamppf S ampp f S Month DayNationalityRegion Dateofbirth Y-eear-+-__------__---==_

~- ~- I 3 ~m FAMILY NAME Given name

4 ~) JFYcl e a~rct middotiffJopa(f5 tffi~fl 6 1lc11~0)1f~ 1f ~ Sex Mal lt-female Placeofbirth Marilal status MarrleampL-BngleI

7 ~ ~ 8 00~t3IT0fi5-1plusmnL1l Occupation Home towncity

9 S 1t3fT01lHC I It x~ll7lltprn)O~2-1-1 ~~~~~B~yenI~xjft~

AddressinJapan

~~~ m~~~ I029-228-8056 Telephone No Ceilular phone No --------r------- shy

fj10 1~ (l )~ (2)1fWJM~amp ampp I S Passport Number Dale ofexpiration Y-ee-ear+- Month Day---__=t

11 AOOsectiyenJ (rJzO)v f1iJ~~ T0 tO) 7r~Iv_e ltt~v o) Purposeofenlry check one of Ihe followings o I r~~J 0 I r~~J 0 J r~J 0 J rX1l TsectliJiJ 0 K r~J o uyena~J

Professor Instructor Artist CulturalActivities Religious ActivIties Joumalist

o L rJ1~fjiyeniibJ 0 M r~B ~~J 0 L r-liJf~ (iyenilUJ) J lntra-company Transferee Business Manager Researcher (Transferee)

o N r-liJf~J 0 N rj1V1~ AXP~middot oo~~rJ 0 N rj1filSJ Researcher Engineer SpecialistinHumanities international Services Skilled l abor

o Nr~flt5WJ(-liJf~Tsecttb ~)J 0 0 rJl1TJ _ p rfjj$J 0 Q r-liJfJ 0 Y rj1frtJ~1sectI (1)J Designated Aclivilles(Researcher or IT engineer of adesignated org) Entertainer Student Trainee Technicallntem Training ( i

o R r~yen1EJ 0 R rjfIETsecttb(-liJf~flt5YttJ~~)J 0 Rr~TsectYttJ(EPA~ )J Dependent Designated Activities (Dependent ofResearcheror ITengineer ofadesignated org) GesignaledAclivilies(Dependenl ofEPA)

o T rSA0)1lc11~~J 0 Tr7k1plusmn~0)IlCfl~~J 0 Tr~1plusmn~J Spouseor ChildofJapanese National Spouse orChild ofPermanent Resident long Term Resident

o riWiJtJllF~~il (1-1) J 0 r~Jt JllF~~ ( H p ) J 0 r~JtJllF~~ (l ) J ourJ(-0)1tJ Highly Skilled Professional(i)(a) Highly Skilled Pnofessional(i)(b) Highly Skilled Pnofessional(i)(c) Others

12 A OO TltEampPfj S ampp f S 13 JJ~T~ft Date ofentry Year Month Day Port ofentry

14 yen(poundTIEMF9 15 1Rl1=F~0)1f1euro 1f-~ Intended length ofstay Accompanying persons if any ytJ~ r-No

16 ~~iE$~TltEf1J Intended place toapply forvisa

17 iamp1-$0) IplusmnJ A 00 ~ fmiddot -middot ---~ Past entry into departure from Japan Ye-rJo

Cl ~ -eW~J~~tRlJ ~) (Fill inthefollowingswhen the answer is Yes)

]Jamp FII f ] miliO)IplusmnJAOO~ ampp fj ampp f S I 1 anytlme(s) The latest entry from Year Month Day to Year Monlh Day

18 ~[~7r~S3 CT0m5H~~TtCO)1f~ (S 007fflOIT0b0)7r2tlo ) Criminal record (In Japanove eas) 1f(AiiyenJfj ) QD Explain if Yes _ _________________________--- ) tJoYes (Delail

19 ill-$~~iliIJXItlplusmnJoofrJfJ01plusmnJ000)1f~ 1f 1euro Departure bydeportation departure order Yes No

Cl ~-a (fi~ ~ ~jlHR IJtA g- ) ]Jamp ] mili0)~~ ampp f S Year Month Day(Fill inthe followings when the answer [s Yes) time(s) The latest departure bydeportation

20 (pound S tll~ (x B 1lC1~T- JL~fr$JKftc) ampLfIRlfi5-~ FamilyinJapan (Father Mother Spouse Son Daughter Brother Sisterorothers)orco-residents

1poundff1tJ 1-lt -1 jamppf S 00 iiHt ~ ~g1JE iIJ~McmiddotJHj~$t 1lfjJll7llt~1fMeJHHn~m

IIndod Iea Resldance card numberNameRelationship Dale ofbirth NationalityRegion with ppicantornol Place ofemploymenUschool Special Permanent Resident Certificate numberI

Fill if any

-~e ------------------------+ ----------------------shyTfr~~-yZ ------------------------------1--- --------------------------------

YesI No Tf~~~-~oZ ----------------------------r-- -------------------------------shy

73ZJflX~5OOA~~(plusmn$~E~~1f -Health Certificate of an International Student for Ibaraki University (for special aUditor~ (ffJJI~~~tl)

H)V (Middle) I

77~~- (Family) 77- ~ (First) 3$m address sect~~ Tzipcode

E pp 0mother riifue

r=gt JIe ~ 3ill~h--Yr

jTT~~C 0

T -j(n

I female

t~amp~ y~ J ~ ~1l1fif ~)yiarsold)

C0checl0

~ 1J audition

)

( (corrected)

( tJ 1J

eyesight

OlEA ~ jt normpoundr

colordiscrimination 0 ~E (

~1flpound method of photographing o r~~ indirectlyDO directly

photograph number

t~~graphing IjZgX 1fshy jj

Y M

COtreatmentOobservation is necessary)

none

FJfJiO~ OpinionO~

yes

A$1~ O)fYt~1F~J a~T~ ~ mO)~~c-trP1G Express existence or nonexistence and detail of any noteworthy illness on the view ofhealth care in the university

aq I ~~I2fJT(1)~L~BC1) ~t3 tJ tsect~rchV =shy ~ ~fIEfjFjT 0 0

I attest above contents based on the results of diagnostics IjZiJX ~ jj (]

date Y M D

address 1plusmnm regtEplusmnfu) -+shy _

nameoftheinstituteorhoopital [3[ ~ r~ ~ ~ -----------+-----=name ofthe doctor andsignature or seal [3[ ~ffi 0) A ~

seal

[~B~o)~] I 1) tJttJ~~EiJ~(b6~~j ~fmlEtJ1J~~CA L-c lttc~ V 2) -to)1t~fl~j~nCAL Jf5tO)ftvlMl-ct~ttMicrrftL ~h1~~~~CAL ~cft~n

-cftv = c iJ ~biJ6 J 5 ~ L-c lttc~v ~ctt~w$fr mJiCplusmn L-ct G5 = c ~ft lJ jTO) -ca~L -clt tc~v o I

[NOTES] 1)Ifeyesight is not normal be sure to fill out the corrected eyesight 2) Please dont leave columns in blank In order to prevent accidental skip please fill any word

eg none

AOO~FIffiffi ~ Ib Director of Imm igrat ion Bureau

Letter of Financial Support

OOflf Nationality

~6 Name

~fF1313 Date of birth

fF Year

13 Mont h

13 Day

(~ fx) (MaleFemal e)

I 5lLdi O)t a JBcO) t O) b~ 13 OOI~ ~OO ~cmO)ffi~)[1fI~ f~ ~ i ~tO) -c rBc O) ~jO ~ ffi~ )[0)51~ sectt~t~rrt~mgFjT~ ~ ~ tl~ffi Jt)[I~-J v -C ~iEgFj ~~T o I have become a financial supporter ofthe above applicant dur ing hisher stay in J apa n and therefore I would like 0 explain the reason for support and make the following stateme nt

1 ffiJt)[ 0)5Ist~tffirrt (ffl ~1f 0) ffi )[ ~ 5 1 )t ~ttgamp affl~1f ~ 0) ~11~ -Jv _C ~yenJ 1~Bc$X L _C ltt-c ~ V 0

Re ason for support (Explain the circumstance and the re lationshi p between yourself an d th e applicant in det ail Also please sta te that you will be responsible for the financi al need) I

---------------------------------------------------------------------------------------------------------------------------------------------------- ----- -------------------------------_

--- - - ----- ------------------ - ----------------------------- - ------------------------ -------------------------- ----middot-------------------middot-------r ---------middot----middot---- -----------------_

---- ----------------------------------------------------- ------------ -- -- - ------------------------------ ------ -----------------------1------------------------------------

--__---_---_--------------------------- ---------------------------------------------------_---------------------------------__---------------- -----__------------------------------_

---------- ------------_--- ---- ----- --- - ----------------------------- ----------------------------------------------------------------- ------ ---- _--------------- -----------------_ _--_

2 gJtXiJa Content of financi al support

_ _ _ _ hereby prove that I will support the above applicant du ring hisher stay in J apan

(1) ~ m13 yen=-fF ~ 1=prlf~ P3 Tuit ion MonthlySemi a nnuallyAnnually JPY

(2) 17iHt 13 tJi Living expenses Monthly amount I~

(3) )[1f1J- (i~ middot1hRi6Jj-~ )[1fyent_~~ijsyenJI~v-C ltt-c~v o) Met hod of support (Explain method of remittance tr ansfer etc)

------- ------------------------------------- --------------------------------------------------- ------------------ --------------- ------------1------------------------------------

-----------------------------------------------------------------------------------------------------------middot------middot--------- ------r --------------------------------------- -------------------------------------------------------------------------------------------------------- ---middot------------ --middot----------middot--T----middot---------middot--middot-------------------

--------- -- ----_--------------- ------------------------------- ------------ --------------------------------------------------------------r-------middot-----middot---middot----------- --------- -shy

-------------------------------------------------------------------------------- ----------- ----- ------------- ------~~-l-------------middot~~---------~~ --

~JtX1f Supporter

1EP)f T Address

Tel E-mail

~6 (w6 ) Name (Signature)

5ft1 ~ 0) Mt Relationship to the applicant

middot e

the recipient of the scholarship will be announced As special measures the

scholarship may be offered preferentially to a student from a partner institution

where imbalance in the number of accepted students is found

Students who are receiving scholarships (except for loans) more than 5~000 JPY per

month however are not eligible for this scholarship We will later Jtotify partner

universities of the possibility that this scholarship can be granted to thJir students

Monthly stipend yen40000 (up to 10 months) This is Only for Perio~

8 Tuition fees etc

Fees are quoted based on the exchange agreement

If the agreement includes the tuition waiver the examination fee the enrollment fee

and the tuition will be exempted I If the agreement does not include the tuition waiver students must pay the following

tuition fee I Fees for official examination Enrollment fee Tuition fee

Special Auditor ----shy -----shy yen l4800~per unit)

Students are required to enroll in a minimum of seven 90-minute classes per week

9 Living expenses

Average living expenses for international students at Ibaraki Univezisity are within

the range of yen50000 to yen100000 per month (The exact amount If the expenses

varies depending on ones choice of housing etc)

10 Health insurance

Exchange students must subscribe to the National Health Insurancer It costs about

2000 yen per month Upon joining the National H ealth Insurance System a National I

Health Insurance Certificate will be issued If she shows this to a medical institution

at the time of receiving medical treatment she will need to pay okly 30 of the

incurred medical cost I Additionally they are required to purchase the Personal Accident Insurance for

Students Pursuing Education and Research (PAISPER) However the range of

activities covered under PAISPER is limited Therefore we recommend that exchange

students buy an insurance for study abroad with a broader coverage j

See further in details Per sonal Accident Insurance for Students Pursuing Education

and Research httpjeesorjpgakkensaiJindexhtm

11 Housing

Exchange students are given priority for living in a university dormitory If no room is

available applicants will need to rent a private apartment near the campus (monthly

rent costs mostly within the range of yen 30000 to yen 35000)

12 Notification ofthe results of applications

The applicants who wish to arrive in Japan in April will receive the results of the

final selection by Ibaraki University between the middle of February and the I

beginning of March Those who wish to arrive in Japan in October 4ill receive the

results in the end of August Note that in some cases Ibaraki University may not be

able to accept all of the applicants

13 Student visa

Once their eligibilities have been confirmed we will send you Ietters of acceptance

and the document issued by the Japanese Immigration called a Certificate of

Eligibility both of which are needed to apply for a student visa

A Guide to Japanese Visas (The Ministry of Foreign Affairs ofJapan)

Japanese httpwwwmofagojpmofajtokovisaindexhtml

English httpwwwmofagojpLinfovisitvisaindexhtml

14 Inquiries

Ifyou have any questions please contact us either by email or fax eit er in Japanese

or English Please put your university name - Ibaraki Exchange on the title line in

your emailfax

We will not accept applications directly sent by applicants We will not answer any

questions directly asked by the applicants

Hiroshi Yasuda

International Exchange Division Ibaraki University

21-1 Bunkyo Mito Ibarakiken 310-8512 Japan

Telephone +81-29-228-8056 Fax +81-29-228-8594

E-mailhiroshiyasudahrvcibarakiacjp

6 (1) 6 photograph

(unit millimeter)

40

so

1 The photograph of only an applicant

2 The size of the photograph is fixed as above The size of head is from top of the

headtincluding hair) to the chin

3 Turn to the front with bare head

4 No background or shadow

5 A clear photograph

6 Has to be taken within three months

Write your nationality name and the date of your birth

Useful information

Ibaraki University

httpwww ibaraki ac jpgeneral infoindex html

International Student Center

httpwwwiscibarakiacmiddotlli

JASSO Student Guide to Japan

(~H) B~~3ZI~t~ rB~~7f1 riJ

httpwww jasso go jpstudy jsgtj html

~AWlr~ (2018iF9FJlB) Period Q) (For those who arrive in Japan in September 2018)

~s~Difm)EI~-Jltif~ilA~t1poundbullbull Recommendation of the Applicants

ToPresident of Ibaraki University

~5J~mtpoundhJE1dQ W~ffl~i3a-~O) cd3~) ttiiLi 0

I recommend the following applicants

First 2~

Second 3~

Third 4~

Fourth 5

Fifth

2018fF9f] 21 B Wi TO)PJT~

(f~ 1) Form 1

~fFa-~cAO)=Co Please fill in the CollegeGraduate school and Year of study at the date of September

iF JJ B Date Year Month Date

~~ Country

A+O

Nameof Institution

~ijlO

Title

JCO

Name

=EO

21st 2018

Signature I I---------------------------------~-------shyI

-yen13J t =l13 ~ren

Contact Person II- 0

name I lgtz~ijlO

t itle I I)lt -jlshy

E-mail I IlIJ-aO

Division I IXrJI

Address I isecti53 I-AX TELFAX I

I

--------------------------------- --------------

------------- -------------

5JrJil2~R~0)=fit (m~sectlkO)=Mi) $~~A~fFPltm 1 OJ ooisectltfltlltim1f

For applicant part 1 Ministry ofJu~tice Government of Japan

o Please fill the yellow columns a1d put tle yeo~ circles on the apprqpri~ terms 1pound ~ if ~ yenJ IE w ~ it ~ 1T Ej3 ~~ it

APPLICATION FOR CERTIFICATE OF ELIGIBILITY

A 00 ifJ1llfpj ~ To the Director General of Regional Immigration Bureau

PhotoIplusmnJAooif~ampLf~~~~$ gfn~0)20)m~~Irj~ rJzO)ct3~PJ$~7sectk~1Ji~21 mlf0 ~1tf1~g-l- -Cv 0 sectjO)WE~if0)~1t7r$~~l-To

40mm x 30mm the certificateshowing eligibility for theconditions provided for in 7Paragraph 1 Item 2of thesaidAct Pursuant to theprovisions ofArticle7-2of theImmigration Control andRefugee Recognition Act I hereby applyfor

1 00 ~plusmnili ~ 2 jamppf S ampp f S Month DayNationalityRegion Dateofbirth Y-eear-+-__------__---==_

~- ~- I 3 ~m FAMILY NAME Given name

4 ~) JFYcl e a~rct middotiffJopa(f5 tffi~fl 6 1lc11~0)1f~ 1f ~ Sex Mal lt-female Placeofbirth Marilal status MarrleampL-BngleI

7 ~ ~ 8 00~t3IT0fi5-1plusmnL1l Occupation Home towncity

9 S 1t3fT01lHC I It x~ll7lltprn)O~2-1-1 ~~~~~B~yenI~xjft~

AddressinJapan

~~~ m~~~ I029-228-8056 Telephone No Ceilular phone No --------r------- shy

fj10 1~ (l )~ (2)1fWJM~amp ampp I S Passport Number Dale ofexpiration Y-ee-ear+- Month Day---__=t

11 AOOsectiyenJ (rJzO)v f1iJ~~ T0 tO) 7r~Iv_e ltt~v o) Purposeofenlry check one of Ihe followings o I r~~J 0 I r~~J 0 J r~J 0 J rX1l TsectliJiJ 0 K r~J o uyena~J

Professor Instructor Artist CulturalActivities Religious ActivIties Joumalist

o L rJ1~fjiyeniibJ 0 M r~B ~~J 0 L r-liJf~ (iyenilUJ) J lntra-company Transferee Business Manager Researcher (Transferee)

o N r-liJf~J 0 N rj1V1~ AXP~middot oo~~rJ 0 N rj1filSJ Researcher Engineer SpecialistinHumanities international Services Skilled l abor

o Nr~flt5WJ(-liJf~Tsecttb ~)J 0 0 rJl1TJ _ p rfjj$J 0 Q r-liJfJ 0 Y rj1frtJ~1sectI (1)J Designated Aclivilles(Researcher or IT engineer of adesignated org) Entertainer Student Trainee Technicallntem Training ( i

o R r~yen1EJ 0 R rjfIETsecttb(-liJf~flt5YttJ~~)J 0 Rr~TsectYttJ(EPA~ )J Dependent Designated Activities (Dependent ofResearcheror ITengineer ofadesignated org) GesignaledAclivilies(Dependenl ofEPA)

o T rSA0)1lc11~~J 0 Tr7k1plusmn~0)IlCfl~~J 0 Tr~1plusmn~J Spouseor ChildofJapanese National Spouse orChild ofPermanent Resident long Term Resident

o riWiJtJllF~~il (1-1) J 0 r~Jt JllF~~ ( H p ) J 0 r~JtJllF~~ (l ) J ourJ(-0)1tJ Highly Skilled Professional(i)(a) Highly Skilled Pnofessional(i)(b) Highly Skilled Pnofessional(i)(c) Others

12 A OO TltEampPfj S ampp f S 13 JJ~T~ft Date ofentry Year Month Day Port ofentry

14 yen(poundTIEMF9 15 1Rl1=F~0)1f1euro 1f-~ Intended length ofstay Accompanying persons if any ytJ~ r-No

16 ~~iE$~TltEf1J Intended place toapply forvisa

17 iamp1-$0) IplusmnJ A 00 ~ fmiddot -middot ---~ Past entry into departure from Japan Ye-rJo

Cl ~ -eW~J~~tRlJ ~) (Fill inthefollowingswhen the answer is Yes)

]Jamp FII f ] miliO)IplusmnJAOO~ ampp fj ampp f S I 1 anytlme(s) The latest entry from Year Month Day to Year Monlh Day

18 ~[~7r~S3 CT0m5H~~TtCO)1f~ (S 007fflOIT0b0)7r2tlo ) Criminal record (In Japanove eas) 1f(AiiyenJfj ) QD Explain if Yes _ _________________________--- ) tJoYes (Delail

19 ill-$~~iliIJXItlplusmnJoofrJfJ01plusmnJ000)1f~ 1f 1euro Departure bydeportation departure order Yes No

Cl ~-a (fi~ ~ ~jlHR IJtA g- ) ]Jamp ] mili0)~~ ampp f S Year Month Day(Fill inthe followings when the answer [s Yes) time(s) The latest departure bydeportation

20 (pound S tll~ (x B 1lC1~T- JL~fr$JKftc) ampLfIRlfi5-~ FamilyinJapan (Father Mother Spouse Son Daughter Brother Sisterorothers)orco-residents

1poundff1tJ 1-lt -1 jamppf S 00 iiHt ~ ~g1JE iIJ~McmiddotJHj~$t 1lfjJll7llt~1fMeJHHn~m

IIndod Iea Resldance card numberNameRelationship Dale ofbirth NationalityRegion with ppicantornol Place ofemploymenUschool Special Permanent Resident Certificate numberI

Fill if any

-~e ------------------------+ ----------------------shyTfr~~-yZ ------------------------------1--- --------------------------------

YesI No Tf~~~-~oZ ----------------------------r-- -------------------------------shy

73ZJflX~5OOA~~(plusmn$~E~~1f -Health Certificate of an International Student for Ibaraki University (for special aUditor~ (ffJJI~~~tl)

H)V (Middle) I

77~~- (Family) 77- ~ (First) 3$m address sect~~ Tzipcode

E pp 0mother riifue

r=gt JIe ~ 3ill~h--Yr

jTT~~C 0

T -j(n

I female

t~amp~ y~ J ~ ~1l1fif ~)yiarsold)

C0checl0

~ 1J audition

)

( (corrected)

( tJ 1J

eyesight

OlEA ~ jt normpoundr

colordiscrimination 0 ~E (

~1flpound method of photographing o r~~ indirectlyDO directly

photograph number

t~~graphing IjZgX 1fshy jj

Y M

COtreatmentOobservation is necessary)

none

FJfJiO~ OpinionO~

yes

A$1~ O)fYt~1F~J a~T~ ~ mO)~~c-trP1G Express existence or nonexistence and detail of any noteworthy illness on the view ofhealth care in the university

aq I ~~I2fJT(1)~L~BC1) ~t3 tJ tsect~rchV =shy ~ ~fIEfjFjT 0 0

I attest above contents based on the results of diagnostics IjZiJX ~ jj (]

date Y M D

address 1plusmnm regtEplusmnfu) -+shy _

nameoftheinstituteorhoopital [3[ ~ r~ ~ ~ -----------+-----=name ofthe doctor andsignature or seal [3[ ~ffi 0) A ~

seal

[~B~o)~] I 1) tJttJ~~EiJ~(b6~~j ~fmlEtJ1J~~CA L-c lttc~ V 2) -to)1t~fl~j~nCAL Jf5tO)ftvlMl-ct~ttMicrrftL ~h1~~~~CAL ~cft~n

-cftv = c iJ ~biJ6 J 5 ~ L-c lttc~v ~ctt~w$fr mJiCplusmn L-ct G5 = c ~ft lJ jTO) -ca~L -clt tc~v o I

[NOTES] 1)Ifeyesight is not normal be sure to fill out the corrected eyesight 2) Please dont leave columns in blank In order to prevent accidental skip please fill any word

eg none

AOO~FIffiffi ~ Ib Director of Imm igrat ion Bureau

Letter of Financial Support

OOflf Nationality

~6 Name

~fF1313 Date of birth

fF Year

13 Mont h

13 Day

(~ fx) (MaleFemal e)

I 5lLdi O)t a JBcO) t O) b~ 13 OOI~ ~OO ~cmO)ffi~)[1fI~ f~ ~ i ~tO) -c rBc O) ~jO ~ ffi~ )[0)51~ sectt~t~rrt~mgFjT~ ~ ~ tl~ffi Jt)[I~-J v -C ~iEgFj ~~T o I have become a financial supporter ofthe above applicant dur ing hisher stay in J apa n and therefore I would like 0 explain the reason for support and make the following stateme nt

1 ffiJt)[ 0)5Ist~tffirrt (ffl ~1f 0) ffi )[ ~ 5 1 )t ~ttgamp affl~1f ~ 0) ~11~ -Jv _C ~yenJ 1~Bc$X L _C ltt-c ~ V 0

Re ason for support (Explain the circumstance and the re lationshi p between yourself an d th e applicant in det ail Also please sta te that you will be responsible for the financi al need) I

---------------------------------------------------------------------------------------------------------------------------------------------------- ----- -------------------------------_

--- - - ----- ------------------ - ----------------------------- - ------------------------ -------------------------- ----middot-------------------middot-------r ---------middot----middot---- -----------------_

---- ----------------------------------------------------- ------------ -- -- - ------------------------------ ------ -----------------------1------------------------------------

--__---_---_--------------------------- ---------------------------------------------------_---------------------------------__---------------- -----__------------------------------_

---------- ------------_--- ---- ----- --- - ----------------------------- ----------------------------------------------------------------- ------ ---- _--------------- -----------------_ _--_

2 gJtXiJa Content of financi al support

_ _ _ _ hereby prove that I will support the above applicant du ring hisher stay in J apan

(1) ~ m13 yen=-fF ~ 1=prlf~ P3 Tuit ion MonthlySemi a nnuallyAnnually JPY

(2) 17iHt 13 tJi Living expenses Monthly amount I~

(3) )[1f1J- (i~ middot1hRi6Jj-~ )[1fyent_~~ijsyenJI~v-C ltt-c~v o) Met hod of support (Explain method of remittance tr ansfer etc)

------- ------------------------------------- --------------------------------------------------- ------------------ --------------- ------------1------------------------------------

-----------------------------------------------------------------------------------------------------------middot------middot--------- ------r --------------------------------------- -------------------------------------------------------------------------------------------------------- ---middot------------ --middot----------middot--T----middot---------middot--middot-------------------

--------- -- ----_--------------- ------------------------------- ------------ --------------------------------------------------------------r-------middot-----middot---middot----------- --------- -shy

-------------------------------------------------------------------------------- ----------- ----- ------------- ------~~-l-------------middot~~---------~~ --

~JtX1f Supporter

1EP)f T Address

Tel E-mail

~6 (w6 ) Name (Signature)

5ft1 ~ 0) Mt Relationship to the applicant

11 Housing

Exchange students are given priority for living in a university dormitory If no room is

available applicants will need to rent a private apartment near the campus (monthly

rent costs mostly within the range of yen 30000 to yen 35000)

12 Notification ofthe results of applications

The applicants who wish to arrive in Japan in April will receive the results of the

final selection by Ibaraki University between the middle of February and the I

beginning of March Those who wish to arrive in Japan in October 4ill receive the

results in the end of August Note that in some cases Ibaraki University may not be

able to accept all of the applicants

13 Student visa

Once their eligibilities have been confirmed we will send you Ietters of acceptance

and the document issued by the Japanese Immigration called a Certificate of

Eligibility both of which are needed to apply for a student visa

A Guide to Japanese Visas (The Ministry of Foreign Affairs ofJapan)

Japanese httpwwwmofagojpmofajtokovisaindexhtml

English httpwwwmofagojpLinfovisitvisaindexhtml

14 Inquiries

Ifyou have any questions please contact us either by email or fax eit er in Japanese

or English Please put your university name - Ibaraki Exchange on the title line in

your emailfax

We will not accept applications directly sent by applicants We will not answer any

questions directly asked by the applicants

Hiroshi Yasuda

International Exchange Division Ibaraki University

21-1 Bunkyo Mito Ibarakiken 310-8512 Japan

Telephone +81-29-228-8056 Fax +81-29-228-8594

E-mailhiroshiyasudahrvcibarakiacjp

6 (1) 6 photograph

(unit millimeter)

40

so

1 The photograph of only an applicant

2 The size of the photograph is fixed as above The size of head is from top of the

headtincluding hair) to the chin

3 Turn to the front with bare head

4 No background or shadow

5 A clear photograph

6 Has to be taken within three months

Write your nationality name and the date of your birth

Useful information

Ibaraki University

httpwww ibaraki ac jpgeneral infoindex html

International Student Center

httpwwwiscibarakiacmiddotlli

JASSO Student Guide to Japan

(~H) B~~3ZI~t~ rB~~7f1 riJ

httpwww jasso go jpstudy jsgtj html

~AWlr~ (2018iF9FJlB) Period Q) (For those who arrive in Japan in September 2018)

~s~Difm)EI~-Jltif~ilA~t1poundbullbull Recommendation of the Applicants

ToPresident of Ibaraki University

~5J~mtpoundhJE1dQ W~ffl~i3a-~O) cd3~) ttiiLi 0

I recommend the following applicants

First 2~

Second 3~

Third 4~

Fourth 5

Fifth

2018fF9f] 21 B Wi TO)PJT~

(f~ 1) Form 1

~fFa-~cAO)=Co Please fill in the CollegeGraduate school and Year of study at the date of September

iF JJ B Date Year Month Date

~~ Country

A+O

Nameof Institution

~ijlO

Title

JCO

Name

=EO

21st 2018

Signature I I---------------------------------~-------shyI

-yen13J t =l13 ~ren

Contact Person II- 0

name I lgtz~ijlO

t itle I I)lt -jlshy

E-mail I IlIJ-aO

Division I IXrJI

Address I isecti53 I-AX TELFAX I

I

--------------------------------- --------------

------------- -------------

5JrJil2~R~0)=fit (m~sectlkO)=Mi) $~~A~fFPltm 1 OJ ooisectltfltlltim1f

For applicant part 1 Ministry ofJu~tice Government of Japan

o Please fill the yellow columns a1d put tle yeo~ circles on the apprqpri~ terms 1pound ~ if ~ yenJ IE w ~ it ~ 1T Ej3 ~~ it

APPLICATION FOR CERTIFICATE OF ELIGIBILITY

A 00 ifJ1llfpj ~ To the Director General of Regional Immigration Bureau

PhotoIplusmnJAooif~ampLf~~~~$ gfn~0)20)m~~Irj~ rJzO)ct3~PJ$~7sectk~1Ji~21 mlf0 ~1tf1~g-l- -Cv 0 sectjO)WE~if0)~1t7r$~~l-To

40mm x 30mm the certificateshowing eligibility for theconditions provided for in 7Paragraph 1 Item 2of thesaidAct Pursuant to theprovisions ofArticle7-2of theImmigration Control andRefugee Recognition Act I hereby applyfor

1 00 ~plusmnili ~ 2 jamppf S ampp f S Month DayNationalityRegion Dateofbirth Y-eear-+-__------__---==_

~- ~- I 3 ~m FAMILY NAME Given name

4 ~) JFYcl e a~rct middotiffJopa(f5 tffi~fl 6 1lc11~0)1f~ 1f ~ Sex Mal lt-female Placeofbirth Marilal status MarrleampL-BngleI

7 ~ ~ 8 00~t3IT0fi5-1plusmnL1l Occupation Home towncity

9 S 1t3fT01lHC I It x~ll7lltprn)O~2-1-1 ~~~~~B~yenI~xjft~

AddressinJapan

~~~ m~~~ I029-228-8056 Telephone No Ceilular phone No --------r------- shy

fj10 1~ (l )~ (2)1fWJM~amp ampp I S Passport Number Dale ofexpiration Y-ee-ear+- Month Day---__=t

11 AOOsectiyenJ (rJzO)v f1iJ~~ T0 tO) 7r~Iv_e ltt~v o) Purposeofenlry check one of Ihe followings o I r~~J 0 I r~~J 0 J r~J 0 J rX1l TsectliJiJ 0 K r~J o uyena~J

Professor Instructor Artist CulturalActivities Religious ActivIties Joumalist

o L rJ1~fjiyeniibJ 0 M r~B ~~J 0 L r-liJf~ (iyenilUJ) J lntra-company Transferee Business Manager Researcher (Transferee)

o N r-liJf~J 0 N rj1V1~ AXP~middot oo~~rJ 0 N rj1filSJ Researcher Engineer SpecialistinHumanities international Services Skilled l abor

o Nr~flt5WJ(-liJf~Tsecttb ~)J 0 0 rJl1TJ _ p rfjj$J 0 Q r-liJfJ 0 Y rj1frtJ~1sectI (1)J Designated Aclivilles(Researcher or IT engineer of adesignated org) Entertainer Student Trainee Technicallntem Training ( i

o R r~yen1EJ 0 R rjfIETsecttb(-liJf~flt5YttJ~~)J 0 Rr~TsectYttJ(EPA~ )J Dependent Designated Activities (Dependent ofResearcheror ITengineer ofadesignated org) GesignaledAclivilies(Dependenl ofEPA)

o T rSA0)1lc11~~J 0 Tr7k1plusmn~0)IlCfl~~J 0 Tr~1plusmn~J Spouseor ChildofJapanese National Spouse orChild ofPermanent Resident long Term Resident

o riWiJtJllF~~il (1-1) J 0 r~Jt JllF~~ ( H p ) J 0 r~JtJllF~~ (l ) J ourJ(-0)1tJ Highly Skilled Professional(i)(a) Highly Skilled Pnofessional(i)(b) Highly Skilled Pnofessional(i)(c) Others

12 A OO TltEampPfj S ampp f S 13 JJ~T~ft Date ofentry Year Month Day Port ofentry

14 yen(poundTIEMF9 15 1Rl1=F~0)1f1euro 1f-~ Intended length ofstay Accompanying persons if any ytJ~ r-No

16 ~~iE$~TltEf1J Intended place toapply forvisa

17 iamp1-$0) IplusmnJ A 00 ~ fmiddot -middot ---~ Past entry into departure from Japan Ye-rJo

Cl ~ -eW~J~~tRlJ ~) (Fill inthefollowingswhen the answer is Yes)

]Jamp FII f ] miliO)IplusmnJAOO~ ampp fj ampp f S I 1 anytlme(s) The latest entry from Year Month Day to Year Monlh Day

18 ~[~7r~S3 CT0m5H~~TtCO)1f~ (S 007fflOIT0b0)7r2tlo ) Criminal record (In Japanove eas) 1f(AiiyenJfj ) QD Explain if Yes _ _________________________--- ) tJoYes (Delail

19 ill-$~~iliIJXItlplusmnJoofrJfJ01plusmnJ000)1f~ 1f 1euro Departure bydeportation departure order Yes No

Cl ~-a (fi~ ~ ~jlHR IJtA g- ) ]Jamp ] mili0)~~ ampp f S Year Month Day(Fill inthe followings when the answer [s Yes) time(s) The latest departure bydeportation

20 (pound S tll~ (x B 1lC1~T- JL~fr$JKftc) ampLfIRlfi5-~ FamilyinJapan (Father Mother Spouse Son Daughter Brother Sisterorothers)orco-residents

1poundff1tJ 1-lt -1 jamppf S 00 iiHt ~ ~g1JE iIJ~McmiddotJHj~$t 1lfjJll7llt~1fMeJHHn~m

IIndod Iea Resldance card numberNameRelationship Dale ofbirth NationalityRegion with ppicantornol Place ofemploymenUschool Special Permanent Resident Certificate numberI

Fill if any

-~e ------------------------+ ----------------------shyTfr~~-yZ ------------------------------1--- --------------------------------

YesI No Tf~~~-~oZ ----------------------------r-- -------------------------------shy

73ZJflX~5OOA~~(plusmn$~E~~1f -Health Certificate of an International Student for Ibaraki University (for special aUditor~ (ffJJI~~~tl)

H)V (Middle) I

77~~- (Family) 77- ~ (First) 3$m address sect~~ Tzipcode

E pp 0mother riifue

r=gt JIe ~ 3ill~h--Yr

jTT~~C 0

T -j(n

I female

t~amp~ y~ J ~ ~1l1fif ~)yiarsold)

C0checl0

~ 1J audition

)

( (corrected)

( tJ 1J

eyesight

OlEA ~ jt normpoundr

colordiscrimination 0 ~E (

~1flpound method of photographing o r~~ indirectlyDO directly

photograph number

t~~graphing IjZgX 1fshy jj

Y M

COtreatmentOobservation is necessary)

none

FJfJiO~ OpinionO~

yes

A$1~ O)fYt~1F~J a~T~ ~ mO)~~c-trP1G Express existence or nonexistence and detail of any noteworthy illness on the view ofhealth care in the university

aq I ~~I2fJT(1)~L~BC1) ~t3 tJ tsect~rchV =shy ~ ~fIEfjFjT 0 0

I attest above contents based on the results of diagnostics IjZiJX ~ jj (]

date Y M D

address 1plusmnm regtEplusmnfu) -+shy _

nameoftheinstituteorhoopital [3[ ~ r~ ~ ~ -----------+-----=name ofthe doctor andsignature or seal [3[ ~ffi 0) A ~

seal

[~B~o)~] I 1) tJttJ~~EiJ~(b6~~j ~fmlEtJ1J~~CA L-c lttc~ V 2) -to)1t~fl~j~nCAL Jf5tO)ftvlMl-ct~ttMicrrftL ~h1~~~~CAL ~cft~n

-cftv = c iJ ~biJ6 J 5 ~ L-c lttc~v ~ctt~w$fr mJiCplusmn L-ct G5 = c ~ft lJ jTO) -ca~L -clt tc~v o I

[NOTES] 1)Ifeyesight is not normal be sure to fill out the corrected eyesight 2) Please dont leave columns in blank In order to prevent accidental skip please fill any word

eg none

AOO~FIffiffi ~ Ib Director of Imm igrat ion Bureau

Letter of Financial Support

OOflf Nationality

~6 Name

~fF1313 Date of birth

fF Year

13 Mont h

13 Day

(~ fx) (MaleFemal e)

I 5lLdi O)t a JBcO) t O) b~ 13 OOI~ ~OO ~cmO)ffi~)[1fI~ f~ ~ i ~tO) -c rBc O) ~jO ~ ffi~ )[0)51~ sectt~t~rrt~mgFjT~ ~ ~ tl~ffi Jt)[I~-J v -C ~iEgFj ~~T o I have become a financial supporter ofthe above applicant dur ing hisher stay in J apa n and therefore I would like 0 explain the reason for support and make the following stateme nt

1 ffiJt)[ 0)5Ist~tffirrt (ffl ~1f 0) ffi )[ ~ 5 1 )t ~ttgamp affl~1f ~ 0) ~11~ -Jv _C ~yenJ 1~Bc$X L _C ltt-c ~ V 0

Re ason for support (Explain the circumstance and the re lationshi p between yourself an d th e applicant in det ail Also please sta te that you will be responsible for the financi al need) I

---------------------------------------------------------------------------------------------------------------------------------------------------- ----- -------------------------------_

--- - - ----- ------------------ - ----------------------------- - ------------------------ -------------------------- ----middot-------------------middot-------r ---------middot----middot---- -----------------_

---- ----------------------------------------------------- ------------ -- -- - ------------------------------ ------ -----------------------1------------------------------------

--__---_---_--------------------------- ---------------------------------------------------_---------------------------------__---------------- -----__------------------------------_

---------- ------------_--- ---- ----- --- - ----------------------------- ----------------------------------------------------------------- ------ ---- _--------------- -----------------_ _--_

2 gJtXiJa Content of financi al support

_ _ _ _ hereby prove that I will support the above applicant du ring hisher stay in J apan

(1) ~ m13 yen=-fF ~ 1=prlf~ P3 Tuit ion MonthlySemi a nnuallyAnnually JPY

(2) 17iHt 13 tJi Living expenses Monthly amount I~

(3) )[1f1J- (i~ middot1hRi6Jj-~ )[1fyent_~~ijsyenJI~v-C ltt-c~v o) Met hod of support (Explain method of remittance tr ansfer etc)

------- ------------------------------------- --------------------------------------------------- ------------------ --------------- ------------1------------------------------------

-----------------------------------------------------------------------------------------------------------middot------middot--------- ------r --------------------------------------- -------------------------------------------------------------------------------------------------------- ---middot------------ --middot----------middot--T----middot---------middot--middot-------------------

--------- -- ----_--------------- ------------------------------- ------------ --------------------------------------------------------------r-------middot-----middot---middot----------- --------- -shy

-------------------------------------------------------------------------------- ----------- ----- ------------- ------~~-l-------------middot~~---------~~ --

~JtX1f Supporter

1EP)f T Address

Tel E-mail

~6 (w6 ) Name (Signature)

5ft1 ~ 0) Mt Relationship to the applicant

6 (1) 6 photograph

(unit millimeter)

40

so

1 The photograph of only an applicant

2 The size of the photograph is fixed as above The size of head is from top of the

headtincluding hair) to the chin

3 Turn to the front with bare head

4 No background or shadow

5 A clear photograph

6 Has to be taken within three months

Write your nationality name and the date of your birth

Useful information

Ibaraki University

httpwww ibaraki ac jpgeneral infoindex html

International Student Center

httpwwwiscibarakiacmiddotlli

JASSO Student Guide to Japan

(~H) B~~3ZI~t~ rB~~7f1 riJ

httpwww jasso go jpstudy jsgtj html

~AWlr~ (2018iF9FJlB) Period Q) (For those who arrive in Japan in September 2018)

~s~Difm)EI~-Jltif~ilA~t1poundbullbull Recommendation of the Applicants

ToPresident of Ibaraki University

~5J~mtpoundhJE1dQ W~ffl~i3a-~O) cd3~) ttiiLi 0

I recommend the following applicants

First 2~

Second 3~

Third 4~

Fourth 5

Fifth

2018fF9f] 21 B Wi TO)PJT~

(f~ 1) Form 1

~fFa-~cAO)=Co Please fill in the CollegeGraduate school and Year of study at the date of September

iF JJ B Date Year Month Date

~~ Country

A+O

Nameof Institution

~ijlO

Title

JCO

Name

=EO

21st 2018

Signature I I---------------------------------~-------shyI

-yen13J t =l13 ~ren

Contact Person II- 0

name I lgtz~ijlO

t itle I I)lt -jlshy

E-mail I IlIJ-aO

Division I IXrJI

Address I isecti53 I-AX TELFAX I

I

--------------------------------- --------------

------------- -------------

5JrJil2~R~0)=fit (m~sectlkO)=Mi) $~~A~fFPltm 1 OJ ooisectltfltlltim1f

For applicant part 1 Ministry ofJu~tice Government of Japan

o Please fill the yellow columns a1d put tle yeo~ circles on the apprqpri~ terms 1pound ~ if ~ yenJ IE w ~ it ~ 1T Ej3 ~~ it

APPLICATION FOR CERTIFICATE OF ELIGIBILITY

A 00 ifJ1llfpj ~ To the Director General of Regional Immigration Bureau

PhotoIplusmnJAooif~ampLf~~~~$ gfn~0)20)m~~Irj~ rJzO)ct3~PJ$~7sectk~1Ji~21 mlf0 ~1tf1~g-l- -Cv 0 sectjO)WE~if0)~1t7r$~~l-To

40mm x 30mm the certificateshowing eligibility for theconditions provided for in 7Paragraph 1 Item 2of thesaidAct Pursuant to theprovisions ofArticle7-2of theImmigration Control andRefugee Recognition Act I hereby applyfor

1 00 ~plusmnili ~ 2 jamppf S ampp f S Month DayNationalityRegion Dateofbirth Y-eear-+-__------__---==_

~- ~- I 3 ~m FAMILY NAME Given name

4 ~) JFYcl e a~rct middotiffJopa(f5 tffi~fl 6 1lc11~0)1f~ 1f ~ Sex Mal lt-female Placeofbirth Marilal status MarrleampL-BngleI

7 ~ ~ 8 00~t3IT0fi5-1plusmnL1l Occupation Home towncity

9 S 1t3fT01lHC I It x~ll7lltprn)O~2-1-1 ~~~~~B~yenI~xjft~

AddressinJapan

~~~ m~~~ I029-228-8056 Telephone No Ceilular phone No --------r------- shy

fj10 1~ (l )~ (2)1fWJM~amp ampp I S Passport Number Dale ofexpiration Y-ee-ear+- Month Day---__=t

11 AOOsectiyenJ (rJzO)v f1iJ~~ T0 tO) 7r~Iv_e ltt~v o) Purposeofenlry check one of Ihe followings o I r~~J 0 I r~~J 0 J r~J 0 J rX1l TsectliJiJ 0 K r~J o uyena~J

Professor Instructor Artist CulturalActivities Religious ActivIties Joumalist

o L rJ1~fjiyeniibJ 0 M r~B ~~J 0 L r-liJf~ (iyenilUJ) J lntra-company Transferee Business Manager Researcher (Transferee)

o N r-liJf~J 0 N rj1V1~ AXP~middot oo~~rJ 0 N rj1filSJ Researcher Engineer SpecialistinHumanities international Services Skilled l abor

o Nr~flt5WJ(-liJf~Tsecttb ~)J 0 0 rJl1TJ _ p rfjj$J 0 Q r-liJfJ 0 Y rj1frtJ~1sectI (1)J Designated Aclivilles(Researcher or IT engineer of adesignated org) Entertainer Student Trainee Technicallntem Training ( i

o R r~yen1EJ 0 R rjfIETsecttb(-liJf~flt5YttJ~~)J 0 Rr~TsectYttJ(EPA~ )J Dependent Designated Activities (Dependent ofResearcheror ITengineer ofadesignated org) GesignaledAclivilies(Dependenl ofEPA)

o T rSA0)1lc11~~J 0 Tr7k1plusmn~0)IlCfl~~J 0 Tr~1plusmn~J Spouseor ChildofJapanese National Spouse orChild ofPermanent Resident long Term Resident

o riWiJtJllF~~il (1-1) J 0 r~Jt JllF~~ ( H p ) J 0 r~JtJllF~~ (l ) J ourJ(-0)1tJ Highly Skilled Professional(i)(a) Highly Skilled Pnofessional(i)(b) Highly Skilled Pnofessional(i)(c) Others

12 A OO TltEampPfj S ampp f S 13 JJ~T~ft Date ofentry Year Month Day Port ofentry

14 yen(poundTIEMF9 15 1Rl1=F~0)1f1euro 1f-~ Intended length ofstay Accompanying persons if any ytJ~ r-No

16 ~~iE$~TltEf1J Intended place toapply forvisa

17 iamp1-$0) IplusmnJ A 00 ~ fmiddot -middot ---~ Past entry into departure from Japan Ye-rJo

Cl ~ -eW~J~~tRlJ ~) (Fill inthefollowingswhen the answer is Yes)

]Jamp FII f ] miliO)IplusmnJAOO~ ampp fj ampp f S I 1 anytlme(s) The latest entry from Year Month Day to Year Monlh Day

18 ~[~7r~S3 CT0m5H~~TtCO)1f~ (S 007fflOIT0b0)7r2tlo ) Criminal record (In Japanove eas) 1f(AiiyenJfj ) QD Explain if Yes _ _________________________--- ) tJoYes (Delail

19 ill-$~~iliIJXItlplusmnJoofrJfJ01plusmnJ000)1f~ 1f 1euro Departure bydeportation departure order Yes No

Cl ~-a (fi~ ~ ~jlHR IJtA g- ) ]Jamp ] mili0)~~ ampp f S Year Month Day(Fill inthe followings when the answer [s Yes) time(s) The latest departure bydeportation

20 (pound S tll~ (x B 1lC1~T- JL~fr$JKftc) ampLfIRlfi5-~ FamilyinJapan (Father Mother Spouse Son Daughter Brother Sisterorothers)orco-residents

1poundff1tJ 1-lt -1 jamppf S 00 iiHt ~ ~g1JE iIJ~McmiddotJHj~$t 1lfjJll7llt~1fMeJHHn~m

IIndod Iea Resldance card numberNameRelationship Dale ofbirth NationalityRegion with ppicantornol Place ofemploymenUschool Special Permanent Resident Certificate numberI

Fill if any

-~e ------------------------+ ----------------------shyTfr~~-yZ ------------------------------1--- --------------------------------

YesI No Tf~~~-~oZ ----------------------------r-- -------------------------------shy

73ZJflX~5OOA~~(plusmn$~E~~1f -Health Certificate of an International Student for Ibaraki University (for special aUditor~ (ffJJI~~~tl)

H)V (Middle) I

77~~- (Family) 77- ~ (First) 3$m address sect~~ Tzipcode

E pp 0mother riifue

r=gt JIe ~ 3ill~h--Yr

jTT~~C 0

T -j(n

I female

t~amp~ y~ J ~ ~1l1fif ~)yiarsold)

C0checl0

~ 1J audition

)

( (corrected)

( tJ 1J

eyesight

OlEA ~ jt normpoundr

colordiscrimination 0 ~E (

~1flpound method of photographing o r~~ indirectlyDO directly

photograph number

t~~graphing IjZgX 1fshy jj

Y M

COtreatmentOobservation is necessary)

none

FJfJiO~ OpinionO~

yes

A$1~ O)fYt~1F~J a~T~ ~ mO)~~c-trP1G Express existence or nonexistence and detail of any noteworthy illness on the view ofhealth care in the university

aq I ~~I2fJT(1)~L~BC1) ~t3 tJ tsect~rchV =shy ~ ~fIEfjFjT 0 0

I attest above contents based on the results of diagnostics IjZiJX ~ jj (]

date Y M D

address 1plusmnm regtEplusmnfu) -+shy _

nameoftheinstituteorhoopital [3[ ~ r~ ~ ~ -----------+-----=name ofthe doctor andsignature or seal [3[ ~ffi 0) A ~

seal

[~B~o)~] I 1) tJttJ~~EiJ~(b6~~j ~fmlEtJ1J~~CA L-c lttc~ V 2) -to)1t~fl~j~nCAL Jf5tO)ftvlMl-ct~ttMicrrftL ~h1~~~~CAL ~cft~n

-cftv = c iJ ~biJ6 J 5 ~ L-c lttc~v ~ctt~w$fr mJiCplusmn L-ct G5 = c ~ft lJ jTO) -ca~L -clt tc~v o I

[NOTES] 1)Ifeyesight is not normal be sure to fill out the corrected eyesight 2) Please dont leave columns in blank In order to prevent accidental skip please fill any word

eg none

AOO~FIffiffi ~ Ib Director of Imm igrat ion Bureau

Letter of Financial Support

OOflf Nationality

~6 Name

~fF1313 Date of birth

fF Year

13 Mont h

13 Day

(~ fx) (MaleFemal e)

I 5lLdi O)t a JBcO) t O) b~ 13 OOI~ ~OO ~cmO)ffi~)[1fI~ f~ ~ i ~tO) -c rBc O) ~jO ~ ffi~ )[0)51~ sectt~t~rrt~mgFjT~ ~ ~ tl~ffi Jt)[I~-J v -C ~iEgFj ~~T o I have become a financial supporter ofthe above applicant dur ing hisher stay in J apa n and therefore I would like 0 explain the reason for support and make the following stateme nt

1 ffiJt)[ 0)5Ist~tffirrt (ffl ~1f 0) ffi )[ ~ 5 1 )t ~ttgamp affl~1f ~ 0) ~11~ -Jv _C ~yenJ 1~Bc$X L _C ltt-c ~ V 0

Re ason for support (Explain the circumstance and the re lationshi p between yourself an d th e applicant in det ail Also please sta te that you will be responsible for the financi al need) I

---------------------------------------------------------------------------------------------------------------------------------------------------- ----- -------------------------------_

--- - - ----- ------------------ - ----------------------------- - ------------------------ -------------------------- ----middot-------------------middot-------r ---------middot----middot---- -----------------_

---- ----------------------------------------------------- ------------ -- -- - ------------------------------ ------ -----------------------1------------------------------------

--__---_---_--------------------------- ---------------------------------------------------_---------------------------------__---------------- -----__------------------------------_

---------- ------------_--- ---- ----- --- - ----------------------------- ----------------------------------------------------------------- ------ ---- _--------------- -----------------_ _--_

2 gJtXiJa Content of financi al support

_ _ _ _ hereby prove that I will support the above applicant du ring hisher stay in J apan

(1) ~ m13 yen=-fF ~ 1=prlf~ P3 Tuit ion MonthlySemi a nnuallyAnnually JPY

(2) 17iHt 13 tJi Living expenses Monthly amount I~

(3) )[1f1J- (i~ middot1hRi6Jj-~ )[1fyent_~~ijsyenJI~v-C ltt-c~v o) Met hod of support (Explain method of remittance tr ansfer etc)

------- ------------------------------------- --------------------------------------------------- ------------------ --------------- ------------1------------------------------------

-----------------------------------------------------------------------------------------------------------middot------middot--------- ------r --------------------------------------- -------------------------------------------------------------------------------------------------------- ---middot------------ --middot----------middot--T----middot---------middot--middot-------------------

--------- -- ----_--------------- ------------------------------- ------------ --------------------------------------------------------------r-------middot-----middot---middot----------- --------- -shy

-------------------------------------------------------------------------------- ----------- ----- ------------- ------~~-l-------------middot~~---------~~ --

~JtX1f Supporter

1EP)f T Address

Tel E-mail

~6 (w6 ) Name (Signature)

5ft1 ~ 0) Mt Relationship to the applicant

~AWlr~ (2018iF9FJlB) Period Q) (For those who arrive in Japan in September 2018)

~s~Difm)EI~-Jltif~ilA~t1poundbullbull Recommendation of the Applicants

ToPresident of Ibaraki University

~5J~mtpoundhJE1dQ W~ffl~i3a-~O) cd3~) ttiiLi 0

I recommend the following applicants

First 2~

Second 3~

Third 4~

Fourth 5

Fifth

2018fF9f] 21 B Wi TO)PJT~

(f~ 1) Form 1

~fFa-~cAO)=Co Please fill in the CollegeGraduate school and Year of study at the date of September

iF JJ B Date Year Month Date

~~ Country

A+O

Nameof Institution

~ijlO

Title

JCO

Name

=EO

21st 2018

Signature I I---------------------------------~-------shyI

-yen13J t =l13 ~ren

Contact Person II- 0

name I lgtz~ijlO

t itle I I)lt -jlshy

E-mail I IlIJ-aO

Division I IXrJI

Address I isecti53 I-AX TELFAX I

I

--------------------------------- --------------

------------- -------------

5JrJil2~R~0)=fit (m~sectlkO)=Mi) $~~A~fFPltm 1 OJ ooisectltfltlltim1f

For applicant part 1 Ministry ofJu~tice Government of Japan

o Please fill the yellow columns a1d put tle yeo~ circles on the apprqpri~ terms 1pound ~ if ~ yenJ IE w ~ it ~ 1T Ej3 ~~ it

APPLICATION FOR CERTIFICATE OF ELIGIBILITY

A 00 ifJ1llfpj ~ To the Director General of Regional Immigration Bureau

PhotoIplusmnJAooif~ampLf~~~~$ gfn~0)20)m~~Irj~ rJzO)ct3~PJ$~7sectk~1Ji~21 mlf0 ~1tf1~g-l- -Cv 0 sectjO)WE~if0)~1t7r$~~l-To

40mm x 30mm the certificateshowing eligibility for theconditions provided for in 7Paragraph 1 Item 2of thesaidAct Pursuant to theprovisions ofArticle7-2of theImmigration Control andRefugee Recognition Act I hereby applyfor

1 00 ~plusmnili ~ 2 jamppf S ampp f S Month DayNationalityRegion Dateofbirth Y-eear-+-__------__---==_

~- ~- I 3 ~m FAMILY NAME Given name

4 ~) JFYcl e a~rct middotiffJopa(f5 tffi~fl 6 1lc11~0)1f~ 1f ~ Sex Mal lt-female Placeofbirth Marilal status MarrleampL-BngleI

7 ~ ~ 8 00~t3IT0fi5-1plusmnL1l Occupation Home towncity

9 S 1t3fT01lHC I It x~ll7lltprn)O~2-1-1 ~~~~~B~yenI~xjft~

AddressinJapan

~~~ m~~~ I029-228-8056 Telephone No Ceilular phone No --------r------- shy

fj10 1~ (l )~ (2)1fWJM~amp ampp I S Passport Number Dale ofexpiration Y-ee-ear+- Month Day---__=t

11 AOOsectiyenJ (rJzO)v f1iJ~~ T0 tO) 7r~Iv_e ltt~v o) Purposeofenlry check one of Ihe followings o I r~~J 0 I r~~J 0 J r~J 0 J rX1l TsectliJiJ 0 K r~J o uyena~J

Professor Instructor Artist CulturalActivities Religious ActivIties Joumalist

o L rJ1~fjiyeniibJ 0 M r~B ~~J 0 L r-liJf~ (iyenilUJ) J lntra-company Transferee Business Manager Researcher (Transferee)

o N r-liJf~J 0 N rj1V1~ AXP~middot oo~~rJ 0 N rj1filSJ Researcher Engineer SpecialistinHumanities international Services Skilled l abor

o Nr~flt5WJ(-liJf~Tsecttb ~)J 0 0 rJl1TJ _ p rfjj$J 0 Q r-liJfJ 0 Y rj1frtJ~1sectI (1)J Designated Aclivilles(Researcher or IT engineer of adesignated org) Entertainer Student Trainee Technicallntem Training ( i

o R r~yen1EJ 0 R rjfIETsecttb(-liJf~flt5YttJ~~)J 0 Rr~TsectYttJ(EPA~ )J Dependent Designated Activities (Dependent ofResearcheror ITengineer ofadesignated org) GesignaledAclivilies(Dependenl ofEPA)

o T rSA0)1lc11~~J 0 Tr7k1plusmn~0)IlCfl~~J 0 Tr~1plusmn~J Spouseor ChildofJapanese National Spouse orChild ofPermanent Resident long Term Resident

o riWiJtJllF~~il (1-1) J 0 r~Jt JllF~~ ( H p ) J 0 r~JtJllF~~ (l ) J ourJ(-0)1tJ Highly Skilled Professional(i)(a) Highly Skilled Pnofessional(i)(b) Highly Skilled Pnofessional(i)(c) Others

12 A OO TltEampPfj S ampp f S 13 JJ~T~ft Date ofentry Year Month Day Port ofentry

14 yen(poundTIEMF9 15 1Rl1=F~0)1f1euro 1f-~ Intended length ofstay Accompanying persons if any ytJ~ r-No

16 ~~iE$~TltEf1J Intended place toapply forvisa

17 iamp1-$0) IplusmnJ A 00 ~ fmiddot -middot ---~ Past entry into departure from Japan Ye-rJo

Cl ~ -eW~J~~tRlJ ~) (Fill inthefollowingswhen the answer is Yes)

]Jamp FII f ] miliO)IplusmnJAOO~ ampp fj ampp f S I 1 anytlme(s) The latest entry from Year Month Day to Year Monlh Day

18 ~[~7r~S3 CT0m5H~~TtCO)1f~ (S 007fflOIT0b0)7r2tlo ) Criminal record (In Japanove eas) 1f(AiiyenJfj ) QD Explain if Yes _ _________________________--- ) tJoYes (Delail

19 ill-$~~iliIJXItlplusmnJoofrJfJ01plusmnJ000)1f~ 1f 1euro Departure bydeportation departure order Yes No

Cl ~-a (fi~ ~ ~jlHR IJtA g- ) ]Jamp ] mili0)~~ ampp f S Year Month Day(Fill inthe followings when the answer [s Yes) time(s) The latest departure bydeportation

20 (pound S tll~ (x B 1lC1~T- JL~fr$JKftc) ampLfIRlfi5-~ FamilyinJapan (Father Mother Spouse Son Daughter Brother Sisterorothers)orco-residents

1poundff1tJ 1-lt -1 jamppf S 00 iiHt ~ ~g1JE iIJ~McmiddotJHj~$t 1lfjJll7llt~1fMeJHHn~m

IIndod Iea Resldance card numberNameRelationship Dale ofbirth NationalityRegion with ppicantornol Place ofemploymenUschool Special Permanent Resident Certificate numberI

Fill if any

-~e ------------------------+ ----------------------shyTfr~~-yZ ------------------------------1--- --------------------------------

YesI No Tf~~~-~oZ ----------------------------r-- -------------------------------shy

73ZJflX~5OOA~~(plusmn$~E~~1f -Health Certificate of an International Student for Ibaraki University (for special aUditor~ (ffJJI~~~tl)

H)V (Middle) I

77~~- (Family) 77- ~ (First) 3$m address sect~~ Tzipcode

E pp 0mother riifue

r=gt JIe ~ 3ill~h--Yr

jTT~~C 0

T -j(n

I female

t~amp~ y~ J ~ ~1l1fif ~)yiarsold)

C0checl0

~ 1J audition

)

( (corrected)

( tJ 1J

eyesight

OlEA ~ jt normpoundr

colordiscrimination 0 ~E (

~1flpound method of photographing o r~~ indirectlyDO directly

photograph number

t~~graphing IjZgX 1fshy jj

Y M

COtreatmentOobservation is necessary)

none

FJfJiO~ OpinionO~

yes

A$1~ O)fYt~1F~J a~T~ ~ mO)~~c-trP1G Express existence or nonexistence and detail of any noteworthy illness on the view ofhealth care in the university

aq I ~~I2fJT(1)~L~BC1) ~t3 tJ tsect~rchV =shy ~ ~fIEfjFjT 0 0

I attest above contents based on the results of diagnostics IjZiJX ~ jj (]

date Y M D

address 1plusmnm regtEplusmnfu) -+shy _

nameoftheinstituteorhoopital [3[ ~ r~ ~ ~ -----------+-----=name ofthe doctor andsignature or seal [3[ ~ffi 0) A ~

seal

[~B~o)~] I 1) tJttJ~~EiJ~(b6~~j ~fmlEtJ1J~~CA L-c lttc~ V 2) -to)1t~fl~j~nCAL Jf5tO)ftvlMl-ct~ttMicrrftL ~h1~~~~CAL ~cft~n

-cftv = c iJ ~biJ6 J 5 ~ L-c lttc~v ~ctt~w$fr mJiCplusmn L-ct G5 = c ~ft lJ jTO) -ca~L -clt tc~v o I

[NOTES] 1)Ifeyesight is not normal be sure to fill out the corrected eyesight 2) Please dont leave columns in blank In order to prevent accidental skip please fill any word

eg none

AOO~FIffiffi ~ Ib Director of Imm igrat ion Bureau

Letter of Financial Support

OOflf Nationality

~6 Name

~fF1313 Date of birth

fF Year

13 Mont h

13 Day

(~ fx) (MaleFemal e)

I 5lLdi O)t a JBcO) t O) b~ 13 OOI~ ~OO ~cmO)ffi~)[1fI~ f~ ~ i ~tO) -c rBc O) ~jO ~ ffi~ )[0)51~ sectt~t~rrt~mgFjT~ ~ ~ tl~ffi Jt)[I~-J v -C ~iEgFj ~~T o I have become a financial supporter ofthe above applicant dur ing hisher stay in J apa n and therefore I would like 0 explain the reason for support and make the following stateme nt

1 ffiJt)[ 0)5Ist~tffirrt (ffl ~1f 0) ffi )[ ~ 5 1 )t ~ttgamp affl~1f ~ 0) ~11~ -Jv _C ~yenJ 1~Bc$X L _C ltt-c ~ V 0

Re ason for support (Explain the circumstance and the re lationshi p between yourself an d th e applicant in det ail Also please sta te that you will be responsible for the financi al need) I

---------------------------------------------------------------------------------------------------------------------------------------------------- ----- -------------------------------_

--- - - ----- ------------------ - ----------------------------- - ------------------------ -------------------------- ----middot-------------------middot-------r ---------middot----middot---- -----------------_

---- ----------------------------------------------------- ------------ -- -- - ------------------------------ ------ -----------------------1------------------------------------

--__---_---_--------------------------- ---------------------------------------------------_---------------------------------__---------------- -----__------------------------------_

---------- ------------_--- ---- ----- --- - ----------------------------- ----------------------------------------------------------------- ------ ---- _--------------- -----------------_ _--_

2 gJtXiJa Content of financi al support

_ _ _ _ hereby prove that I will support the above applicant du ring hisher stay in J apan

(1) ~ m13 yen=-fF ~ 1=prlf~ P3 Tuit ion MonthlySemi a nnuallyAnnually JPY

(2) 17iHt 13 tJi Living expenses Monthly amount I~

(3) )[1f1J- (i~ middot1hRi6Jj-~ )[1fyent_~~ijsyenJI~v-C ltt-c~v o) Met hod of support (Explain method of remittance tr ansfer etc)

------- ------------------------------------- --------------------------------------------------- ------------------ --------------- ------------1------------------------------------

-----------------------------------------------------------------------------------------------------------middot------middot--------- ------r --------------------------------------- -------------------------------------------------------------------------------------------------------- ---middot------------ --middot----------middot--T----middot---------middot--middot-------------------

--------- -- ----_--------------- ------------------------------- ------------ --------------------------------------------------------------r-------middot-----middot---middot----------- --------- -shy

-------------------------------------------------------------------------------- ----------- ----- ------------- ------~~-l-------------middot~~---------~~ --

~JtX1f Supporter

1EP)f T Address

Tel E-mail

~6 (w6 ) Name (Signature)

5ft1 ~ 0) Mt Relationship to the applicant

--------------------------------- --------------

------------- -------------

5JrJil2~R~0)=fit (m~sectlkO)=Mi) $~~A~fFPltm 1 OJ ooisectltfltlltim1f

For applicant part 1 Ministry ofJu~tice Government of Japan

o Please fill the yellow columns a1d put tle yeo~ circles on the apprqpri~ terms 1pound ~ if ~ yenJ IE w ~ it ~ 1T Ej3 ~~ it

APPLICATION FOR CERTIFICATE OF ELIGIBILITY

A 00 ifJ1llfpj ~ To the Director General of Regional Immigration Bureau

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40mm x 30mm the certificateshowing eligibility for theconditions provided for in 7Paragraph 1 Item 2of thesaidAct Pursuant to theprovisions ofArticle7-2of theImmigration Control andRefugee Recognition Act I hereby applyfor

1 00 ~plusmnili ~ 2 jamppf S ampp f S Month DayNationalityRegion Dateofbirth Y-eear-+-__------__---==_

~- ~- I 3 ~m FAMILY NAME Given name

4 ~) JFYcl e a~rct middotiffJopa(f5 tffi~fl 6 1lc11~0)1f~ 1f ~ Sex Mal lt-female Placeofbirth Marilal status MarrleampL-BngleI

7 ~ ~ 8 00~t3IT0fi5-1plusmnL1l Occupation Home towncity

9 S 1t3fT01lHC I It x~ll7lltprn)O~2-1-1 ~~~~~B~yenI~xjft~

AddressinJapan

~~~ m~~~ I029-228-8056 Telephone No Ceilular phone No --------r------- shy

fj10 1~ (l )~ (2)1fWJM~amp ampp I S Passport Number Dale ofexpiration Y-ee-ear+- Month Day---__=t

11 AOOsectiyenJ (rJzO)v f1iJ~~ T0 tO) 7r~Iv_e ltt~v o) Purposeofenlry check one of Ihe followings o I r~~J 0 I r~~J 0 J r~J 0 J rX1l TsectliJiJ 0 K r~J o uyena~J

Professor Instructor Artist CulturalActivities Religious ActivIties Joumalist

o L rJ1~fjiyeniibJ 0 M r~B ~~J 0 L r-liJf~ (iyenilUJ) J lntra-company Transferee Business Manager Researcher (Transferee)

o N r-liJf~J 0 N rj1V1~ AXP~middot oo~~rJ 0 N rj1filSJ Researcher Engineer SpecialistinHumanities international Services Skilled l abor

o Nr~flt5WJ(-liJf~Tsecttb ~)J 0 0 rJl1TJ _ p rfjj$J 0 Q r-liJfJ 0 Y rj1frtJ~1sectI (1)J Designated Aclivilles(Researcher or IT engineer of adesignated org) Entertainer Student Trainee Technicallntem Training ( i

o R r~yen1EJ 0 R rjfIETsecttb(-liJf~flt5YttJ~~)J 0 Rr~TsectYttJ(EPA~ )J Dependent Designated Activities (Dependent ofResearcheror ITengineer ofadesignated org) GesignaledAclivilies(Dependenl ofEPA)

o T rSA0)1lc11~~J 0 Tr7k1plusmn~0)IlCfl~~J 0 Tr~1plusmn~J Spouseor ChildofJapanese National Spouse orChild ofPermanent Resident long Term Resident

o riWiJtJllF~~il (1-1) J 0 r~Jt JllF~~ ( H p ) J 0 r~JtJllF~~ (l ) J ourJ(-0)1tJ Highly Skilled Professional(i)(a) Highly Skilled Pnofessional(i)(b) Highly Skilled Pnofessional(i)(c) Others

12 A OO TltEampPfj S ampp f S 13 JJ~T~ft Date ofentry Year Month Day Port ofentry

14 yen(poundTIEMF9 15 1Rl1=F~0)1f1euro 1f-~ Intended length ofstay Accompanying persons if any ytJ~ r-No

16 ~~iE$~TltEf1J Intended place toapply forvisa

17 iamp1-$0) IplusmnJ A 00 ~ fmiddot -middot ---~ Past entry into departure from Japan Ye-rJo

Cl ~ -eW~J~~tRlJ ~) (Fill inthefollowingswhen the answer is Yes)

]Jamp FII f ] miliO)IplusmnJAOO~ ampp fj ampp f S I 1 anytlme(s) The latest entry from Year Month Day to Year Monlh Day

18 ~[~7r~S3 CT0m5H~~TtCO)1f~ (S 007fflOIT0b0)7r2tlo ) Criminal record (In Japanove eas) 1f(AiiyenJfj ) QD Explain if Yes _ _________________________--- ) tJoYes (Delail

19 ill-$~~iliIJXItlplusmnJoofrJfJ01plusmnJ000)1f~ 1f 1euro Departure bydeportation departure order Yes No

Cl ~-a (fi~ ~ ~jlHR IJtA g- ) ]Jamp ] mili0)~~ ampp f S Year Month Day(Fill inthe followings when the answer [s Yes) time(s) The latest departure bydeportation

20 (pound S tll~ (x B 1lC1~T- JL~fr$JKftc) ampLfIRlfi5-~ FamilyinJapan (Father Mother Spouse Son Daughter Brother Sisterorothers)orco-residents

1poundff1tJ 1-lt -1 jamppf S 00 iiHt ~ ~g1JE iIJ~McmiddotJHj~$t 1lfjJll7llt~1fMeJHHn~m

IIndod Iea Resldance card numberNameRelationship Dale ofbirth NationalityRegion with ppicantornol Place ofemploymenUschool Special Permanent Resident Certificate numberI

Fill if any

-~e ------------------------+ ----------------------shyTfr~~-yZ ------------------------------1--- --------------------------------

YesI No Tf~~~-~oZ ----------------------------r-- -------------------------------shy

73ZJflX~5OOA~~(plusmn$~E~~1f -Health Certificate of an International Student for Ibaraki University (for special aUditor~ (ffJJI~~~tl)

H)V (Middle) I

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photograph number

t~~graphing IjZgX 1fshy jj

Y M

COtreatmentOobservation is necessary)

none

FJfJiO~ OpinionO~

yes

A$1~ O)fYt~1F~J a~T~ ~ mO)~~c-trP1G Express existence or nonexistence and detail of any noteworthy illness on the view ofhealth care in the university

aq I ~~I2fJT(1)~L~BC1) ~t3 tJ tsect~rchV =shy ~ ~fIEfjFjT 0 0

I attest above contents based on the results of diagnostics IjZiJX ~ jj (]

date Y M D

address 1plusmnm regtEplusmnfu) -+shy _

nameoftheinstituteorhoopital [3[ ~ r~ ~ ~ -----------+-----=name ofthe doctor andsignature or seal [3[ ~ffi 0) A ~

seal

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[NOTES] 1)Ifeyesight is not normal be sure to fill out the corrected eyesight 2) Please dont leave columns in blank In order to prevent accidental skip please fill any word

eg none

AOO~FIffiffi ~ Ib Director of Imm igrat ion Bureau

Letter of Financial Support

OOflf Nationality

~6 Name

~fF1313 Date of birth

fF Year

13 Mont h

13 Day

(~ fx) (MaleFemal e)

I 5lLdi O)t a JBcO) t O) b~ 13 OOI~ ~OO ~cmO)ffi~)[1fI~ f~ ~ i ~tO) -c rBc O) ~jO ~ ffi~ )[0)51~ sectt~t~rrt~mgFjT~ ~ ~ tl~ffi Jt)[I~-J v -C ~iEgFj ~~T o I have become a financial supporter ofthe above applicant dur ing hisher stay in J apa n and therefore I would like 0 explain the reason for support and make the following stateme nt

1 ffiJt)[ 0)5Ist~tffirrt (ffl ~1f 0) ffi )[ ~ 5 1 )t ~ttgamp affl~1f ~ 0) ~11~ -Jv _C ~yenJ 1~Bc$X L _C ltt-c ~ V 0

Re ason for support (Explain the circumstance and the re lationshi p between yourself an d th e applicant in det ail Also please sta te that you will be responsible for the financi al need) I

---------------------------------------------------------------------------------------------------------------------------------------------------- ----- -------------------------------_

--- - - ----- ------------------ - ----------------------------- - ------------------------ -------------------------- ----middot-------------------middot-------r ---------middot----middot---- -----------------_

---- ----------------------------------------------------- ------------ -- -- - ------------------------------ ------ -----------------------1------------------------------------

--__---_---_--------------------------- ---------------------------------------------------_---------------------------------__---------------- -----__------------------------------_

---------- ------------_--- ---- ----- --- - ----------------------------- ----------------------------------------------------------------- ------ ---- _--------------- -----------------_ _--_

2 gJtXiJa Content of financi al support

_ _ _ _ hereby prove that I will support the above applicant du ring hisher stay in J apan

(1) ~ m13 yen=-fF ~ 1=prlf~ P3 Tuit ion MonthlySemi a nnuallyAnnually JPY

(2) 17iHt 13 tJi Living expenses Monthly amount I~

(3) )[1f1J- (i~ middot1hRi6Jj-~ )[1fyent_~~ijsyenJI~v-C ltt-c~v o) Met hod of support (Explain method of remittance tr ansfer etc)

------- ------------------------------------- --------------------------------------------------- ------------------ --------------- ------------1------------------------------------

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--------- -- ----_--------------- ------------------------------- ------------ --------------------------------------------------------------r-------middot-----middot---middot----------- --------- -shy

-------------------------------------------------------------------------------- ----------- ----- ------------- ------~~-l-------------middot~~---------~~ --

~JtX1f Supporter

1EP)f T Address

Tel E-mail

~6 (w6 ) Name (Signature)

5ft1 ~ 0) Mt Relationship to the applicant

73ZJflX~5OOA~~(plusmn$~E~~1f -Health Certificate of an International Student for Ibaraki University (for special aUditor~ (ffJJI~~~tl)

H)V (Middle) I

77~~- (Family) 77- ~ (First) 3$m address sect~~ Tzipcode

E pp 0mother riifue

r=gt JIe ~ 3ill~h--Yr

jTT~~C 0

T -j(n

I female

t~amp~ y~ J ~ ~1l1fif ~)yiarsold)

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~ 1J audition

)

( (corrected)

( tJ 1J

eyesight

OlEA ~ jt normpoundr

colordiscrimination 0 ~E (

~1flpound method of photographing o r~~ indirectlyDO directly

photograph number

t~~graphing IjZgX 1fshy jj

Y M

COtreatmentOobservation is necessary)

none

FJfJiO~ OpinionO~

yes

A$1~ O)fYt~1F~J a~T~ ~ mO)~~c-trP1G Express existence or nonexistence and detail of any noteworthy illness on the view ofhealth care in the university

aq I ~~I2fJT(1)~L~BC1) ~t3 tJ tsect~rchV =shy ~ ~fIEfjFjT 0 0

I attest above contents based on the results of diagnostics IjZiJX ~ jj (]

date Y M D

address 1plusmnm regtEplusmnfu) -+shy _

nameoftheinstituteorhoopital [3[ ~ r~ ~ ~ -----------+-----=name ofthe doctor andsignature or seal [3[ ~ffi 0) A ~

seal

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-cftv = c iJ ~biJ6 J 5 ~ L-c lttc~v ~ctt~w$fr mJiCplusmn L-ct G5 = c ~ft lJ jTO) -ca~L -clt tc~v o I

[NOTES] 1)Ifeyesight is not normal be sure to fill out the corrected eyesight 2) Please dont leave columns in blank In order to prevent accidental skip please fill any word

eg none

AOO~FIffiffi ~ Ib Director of Imm igrat ion Bureau

Letter of Financial Support

OOflf Nationality

~6 Name

~fF1313 Date of birth

fF Year

13 Mont h

13 Day

(~ fx) (MaleFemal e)

I 5lLdi O)t a JBcO) t O) b~ 13 OOI~ ~OO ~cmO)ffi~)[1fI~ f~ ~ i ~tO) -c rBc O) ~jO ~ ffi~ )[0)51~ sectt~t~rrt~mgFjT~ ~ ~ tl~ffi Jt)[I~-J v -C ~iEgFj ~~T o I have become a financial supporter ofthe above applicant dur ing hisher stay in J apa n and therefore I would like 0 explain the reason for support and make the following stateme nt

1 ffiJt)[ 0)5Ist~tffirrt (ffl ~1f 0) ffi )[ ~ 5 1 )t ~ttgamp affl~1f ~ 0) ~11~ -Jv _C ~yenJ 1~Bc$X L _C ltt-c ~ V 0

Re ason for support (Explain the circumstance and the re lationshi p between yourself an d th e applicant in det ail Also please sta te that you will be responsible for the financi al need) I

---------------------------------------------------------------------------------------------------------------------------------------------------- ----- -------------------------------_

--- - - ----- ------------------ - ----------------------------- - ------------------------ -------------------------- ----middot-------------------middot-------r ---------middot----middot---- -----------------_

---- ----------------------------------------------------- ------------ -- -- - ------------------------------ ------ -----------------------1------------------------------------

--__---_---_--------------------------- ---------------------------------------------------_---------------------------------__---------------- -----__------------------------------_

---------- ------------_--- ---- ----- --- - ----------------------------- ----------------------------------------------------------------- ------ ---- _--------------- -----------------_ _--_

2 gJtXiJa Content of financi al support

_ _ _ _ hereby prove that I will support the above applicant du ring hisher stay in J apan

(1) ~ m13 yen=-fF ~ 1=prlf~ P3 Tuit ion MonthlySemi a nnuallyAnnually JPY

(2) 17iHt 13 tJi Living expenses Monthly amount I~

(3) )[1f1J- (i~ middot1hRi6Jj-~ )[1fyent_~~ijsyenJI~v-C ltt-c~v o) Met hod of support (Explain method of remittance tr ansfer etc)

------- ------------------------------------- --------------------------------------------------- ------------------ --------------- ------------1------------------------------------

-----------------------------------------------------------------------------------------------------------middot------middot--------- ------r --------------------------------------- -------------------------------------------------------------------------------------------------------- ---middot------------ --middot----------middot--T----middot---------middot--middot-------------------

--------- -- ----_--------------- ------------------------------- ------------ --------------------------------------------------------------r-------middot-----middot---middot----------- --------- -shy

-------------------------------------------------------------------------------- ----------- ----- ------------- ------~~-l-------------middot~~---------~~ --

~JtX1f Supporter

1EP)f T Address

Tel E-mail

~6 (w6 ) Name (Signature)

5ft1 ~ 0) Mt Relationship to the applicant

AOO~FIffiffi ~ Ib Director of Imm igrat ion Bureau

Letter of Financial Support

OOflf Nationality

~6 Name

~fF1313 Date of birth

fF Year

13 Mont h

13 Day

(~ fx) (MaleFemal e)

I 5lLdi O)t a JBcO) t O) b~ 13 OOI~ ~OO ~cmO)ffi~)[1fI~ f~ ~ i ~tO) -c rBc O) ~jO ~ ffi~ )[0)51~ sectt~t~rrt~mgFjT~ ~ ~ tl~ffi Jt)[I~-J v -C ~iEgFj ~~T o I have become a financial supporter ofthe above applicant dur ing hisher stay in J apa n and therefore I would like 0 explain the reason for support and make the following stateme nt

1 ffiJt)[ 0)5Ist~tffirrt (ffl ~1f 0) ffi )[ ~ 5 1 )t ~ttgamp affl~1f ~ 0) ~11~ -Jv _C ~yenJ 1~Bc$X L _C ltt-c ~ V 0

Re ason for support (Explain the circumstance and the re lationshi p between yourself an d th e applicant in det ail Also please sta te that you will be responsible for the financi al need) I

---------------------------------------------------------------------------------------------------------------------------------------------------- ----- -------------------------------_

--- - - ----- ------------------ - ----------------------------- - ------------------------ -------------------------- ----middot-------------------middot-------r ---------middot----middot---- -----------------_

---- ----------------------------------------------------- ------------ -- -- - ------------------------------ ------ -----------------------1------------------------------------

--__---_---_--------------------------- ---------------------------------------------------_---------------------------------__---------------- -----__------------------------------_

---------- ------------_--- ---- ----- --- - ----------------------------- ----------------------------------------------------------------- ------ ---- _--------------- -----------------_ _--_

2 gJtXiJa Content of financi al support

_ _ _ _ hereby prove that I will support the above applicant du ring hisher stay in J apan

(1) ~ m13 yen=-fF ~ 1=prlf~ P3 Tuit ion MonthlySemi a nnuallyAnnually JPY

(2) 17iHt 13 tJi Living expenses Monthly amount I~

(3) )[1f1J- (i~ middot1hRi6Jj-~ )[1fyent_~~ijsyenJI~v-C ltt-c~v o) Met hod of support (Explain method of remittance tr ansfer etc)

------- ------------------------------------- --------------------------------------------------- ------------------ --------------- ------------1------------------------------------

-----------------------------------------------------------------------------------------------------------middot------middot--------- ------r --------------------------------------- -------------------------------------------------------------------------------------------------------- ---middot------------ --middot----------middot--T----middot---------middot--middot-------------------

--------- -- ----_--------------- ------------------------------- ------------ --------------------------------------------------------------r-------middot-----middot---middot----------- --------- -shy

-------------------------------------------------------------------------------- ----------- ----- ------------- ------~~-l-------------middot~~---------~~ --

~JtX1f Supporter

1EP)f T Address

Tel E-mail

~6 (w6 ) Name (Signature)

5ft1 ~ 0) Mt Relationship to the applicant