example: fill out this form either in english or …...guidelines for completing the application...

フリガナツクバ　タロウ

Name

CurrentAddress

[ E-mail Address: ○○○○@○○○○　 ]

M

Date of Birth / Age

2

筑波太郎(Taro Tsukuba)

Master's Program

Graduate Admissions 2021Joint Master’s Program in International Development and Peace through Sport

(University of Tsukuba, National Institute of Fitness and Sports in Kanoya)

Fill in or circle the following items. (See the Guidelines for Completing theApplication Form.) Please do not fill in the fields marked with ※.

※ExamineeNumber

4ApplicationMethod (2)

(1)ApplicationMethod (1)

GeneralAdmission

GovernmentSponsored

1

2PrivatelyFunded 8

Foreign StudentStatus at the

Time ofApplication

Entrance in FallCooperative

Graduate

0

WorkingIndividuals

13ResearchStudent/Others

※

Status atthe Time ofApplication

2Student

2

Private

Reference(InsideJapan)

3

1

Relation-ship

Name

[ Phone: ○○○ ( ○○○) ○○○○]　　[ Cell Phone: ○○○ ( ○○○○)　○○○○ ]

(　　　○ ○ ○ ○　　○ ○ ○ )

３０５－○○○○

父○ ○　　○　○

[ Phone: ○○○（ ○○○ ）○○○○ ] 　　　　茨城県土浦市下高津○丁目○番地○号Address

※

Research Field (Supervisor's Name)

Oth

erPublic 2School/Faculty

○○大学

School/Department

3

2

University(Graduate School)

Exp

ect t

oC

ompl

ete

5

4

※

51

Gra

duat

ed

2 32021

Com

plet

ed

If you have completed (or are attending) a graduate school, write the name in the "Curriculum Vitae."

Mon

th

4

※Note: Foreign students must acquire the residence status of "Student" before

3

GraduateSchool

Year

Oth

er

Applicable Eligibility※

Year and Monthof (Expected)Completion

5

Sex

WrittenExamination

<Attachment>Attach the "Receipt of examination fee" or "Certificate of postal transfer payment" here.

Secure with glue.

Public

ProgramOther

Year and Monthof (Expected)Graduation

the enrollment procedure.

1

English

Program Name

Professional(except part-

time)

スポーツとジェンダー・人種・民族（清水諭）

○○○学部

Joint Master’s Program in International Developmentand Peace through Sport

Oral Examination

茨城県つくば市天久保５丁目３番地　　○○○アパートB棟３０５室

Exa

mS

ub

ject

s

Foreign

Elig

ibili

ty

Private

5

Mon

thYear

National

Foreign

Year Month Date Age

○○○○ ○○ ○○ ○○

F

Other

4

1

University

Exp

ect t

oG

radu

ate

National

DomicileCode

茨城(Country namefor foreigners)

PermanentDomicile

ResearchInstitute

Code

Example: Fill out this form either in English or Japanese.

If you are granted Monbukagakusho scholarship, circle "1." If not, circle "2."

Please do not fill

in this field.

1

３０５－○○○○

Fill in the fields referring to "Guidelines for Completing the Application Form" (Domicile Code) on the next page.

Fill in the fields enclosed by heavy lines. Refer to "Guidelines for Completing the ApplicationForm" on the following pages.

Please do not fill in these fields.

Required

○○○学科

Guidelines for Completing the Application Form1. Enter your name, date of birth, and gender correctly in the application form. This information will be used as

your identification.2. Please do not fill in the fields marked with ※.3. Enter your permanent domicile in the “Permanent Domicile” field and permanent domicile code in the

“Domicile Code” field with reference to the table below. If you are a foreign national, enter the name of yourcountry in the “Permanent Domicile” field.

[Domicile Code]

4. In the “Reference” field, enter the information of a person who lives in Japan and can contact the applicant.If you are a foreign student granted the Japanese government Monbukagakusho (MEXT) Scholarship,provide a name other than “Monbukagakusho.”

5. Specify your desired research field and supervisor’s name in the “Research Field (Supervisor’s Name)”field as shown in the “List of Research Fields.”

6. Enter the name of the school you completed or graduated from in the “Eligibility” field according to thecorresponding eligibility.

7. Notify us promptly if there is any change in your contact information after submitting the application form.

北海道

Hokkaido 01

埼玉県

Saitama 11

岐阜県

Gifu 21

鳥取県

Tottori 31

佐賀県

Saga 41

青森県

Aomori 02

千葉県

Chiba 12

静岡県

Shizuoka 22

島根県

Shimane 32

長崎県

Nagasaki 42

岩手県

Iwate 03

東京都

Tokyo 13

愛知県

Aichi 23

岡山県

Okayama 33

熊本県

Kumamoto 43

宮城県

Miyagi 04

神奈川県

Kanagawa 14

三重県

Mie 24

広島県

Hiroshima 34

大分県

Oita 44

秋田県

Akita 05

新潟県

Niigata 15

滋賀県

Shiga 25

山口県

Yamaguchi 35

宮崎県

Miyazaki 45

山形県

Yamagata 06

富山県

Toyama 16

京都府

Kyoto 26

徳島県

Tokushima 36

鹿児島県

Kagoshima 46

福島県

Fukushima 07

石川県

Ishikawa 17

大阪府

Osaka 27

香川県

Kagawa 37

沖縄県

Okinawa 47

茨城県

Ibaraki 08

福井県

Fukui 18

兵庫県

Hyogo 28

愛媛県

Ehime 38

栃木県

Tochigi 09

山梨県

Yamanashi 19

奈良県

Nara 29

高知県

Kochi 39

群馬県

Gunma 10

長野県

Nagano 20

和歌山県

Wakayama 30

福岡県

Fukuoka 40

Y ○○○○ M 4

Y ○○○○ M 3

Y ○○○○ M 4

Y ○○○○ M 3

Y M

Y M

Y M

Y M

Y M

Y M

Y M

Y M

ExpectedDate of

Graduation

NameFamily First

筑波太郎

Middle/ Other

Date ofGraduation

Date ofEntrance

Date ofEntrance

○○○高等学校

○○○高等学校

Master's Program

Curriculum Vitae

(Note) 1. This form is for Japanese students only. Foreign student must use the designated form.2. Enter your education higher than high school. If you have enrolled in the University as a research student or

credited auditor (auditing student), enter the period of enrollment as well.3. If we found that you made a false entry or didn't write necessary information in this form after entrance,

your admission shall be void.4. Please do not fill in the fields marked with ※.5. As necessary, delete "Graduation" with a double line and write "Completion" on the left.

ExpectedDate of

Graduation

Educ

atio

n

Date ofEntrance

○○○大学

ExamineeNumber

※

○○○大学

Joint Master’s Program in

International Development and Peace through Sport

ExpectedDate of

Graduation

Date ofEntrance

Please do not fill in this field.


履歴書Curriculum Vitae

氏名

フリガナ

ローマ字

○○○○ ○○○○男(Ｍ)

・

女(Ｆ)

Sex

生年月日

Date of Birth Year Month Date 19○○ ○○ ○○

年齢

Age ○

国籍

Nationality ○○○

在留資格

Resident Status

College Student ○○○○ ○○○○

Family Name First Name Middle Name

学校教育

Education

学校名・所在地

Name and Address of School

正規の修学年数

Officially Required Number of Years of Schooling

入学及び卒業年月

Year and Month of Entrance and Completion

修業年数

Period of Schooling

専攻科目

Major Subject if any

学位・資格

Diploma or Degree Awarded

初等教育Elementary Education

小学校Elementary School

学校名 ○○○○ elementary school Name 所在地 Bangkok / Thailand Location

年yrs

６

入学 ○○○○.4 from 卒業 ○○○○.3 to

年yrs

６

中等教育 Secondary Education

中学及び高校

Secondary School

中学

Lower

学校名 ○○○○ lower secondary school Name 所在地 ○○○○○○○○○○○○Location

年yrs

３

入学 ○○○○.4 from 卒業 ○○○○.3 to

年yrs

３

高校

Upper

学校名 ○○○ Upper secondary school Name 所在地 ○○○○○○○○○○○○Location

年yrs

３

入学 ○○○○.4 from 卒業 ○○○○.3 to

年yrs

３

高等教育 Higher Education 大学

Undergraduate Level

学校名 ○○○ University of ○○○ Name 所在地 ○○○○○○○○○○○○Location

年yrs

４

入学 ○○○○.4 from 卒業 ○○○○.3 to

年yrs

４ ○○○○○○ Bachelor of ○○○

高等教育 Higher Education 大学院

Graduate Level

学校名Name 所在地Location

年yrs

入学from 卒業to

年yrs

以上を通算した全学校教育就学年数

Total Number of Years of Schooling as given Above 年

yrs TOTAL 年

yrs

休学等、在籍中に修学を中断した期間（理由） Periods of interruption of studies, if any from 年 yr., 月 mon.～to 年 yr., 月 mon.（）

研究歴

Research Activities (研究生の

経歴を含

む。)

研究機関名Name of Research Institution

所在地Address

身分Status

研究期間Duration of Research

年数yrs

University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8577 Japan Research student ○○○○.4 ～ ○○○○.3 ○

～

～

記入は、日本語又はローマ字体を用いてください。 Please type or print in Japanese or English.

( 外国人出願者用 )

(for foreign applicants)

※

受験

番号

～

～

～

～～

１６１６

記入例

Example

記

入

し

な

い

Do not fill in this field.

Examinee Number ※

Name Family First Middle / Other

Program Joint Master’s Program in International Development and Peace through Sport 筑波太郎

Date of Birth Year

○○○○

Month ○○

Date ○○

Course / Field Field: スポーツとジェンダー・人種・民

族

If you have an employment history, describe all of your previous and current jobs including job titles, responsibilities, and research content. If you need more space, make a photocopy of this form.

Employment Period Year 2018 Month 4 – Year 2019 Month 10

Company / Organization

Full-time Part-time

Job Title / Responsibilities / Research Content

○○○第二課技術課員

○○○地域を担当し、○○○の管理を担当。

○○○の検査、○○○の調査・統計及び分析を業務とした。○

Employment Period Year 2019 Month 11 – Year 2020 Month 3


Full-time Part-time


○○研究員

○○○○○○の研究の補助として、○○○の測定、○○○の解析を行っている。

Employment Period Year Month – Year Month


Full-time Part-time


Employment Record Please do not fill in this field.

株式会社○○○○


○○○○研究所○○○センター

Cut here

Joint Master’s Program inInternational Developmentand Peace through Sport

○

スポーツとジェンダー・人種・民族

※

Cut

her

e

Program /Field

ExamineeNumber

Master's Program Master's Program



Field



OralExamina-

tionEnglish

WrittenExamina-

tion

Photo CardAdmission Ticket forExamination

ExamineeNumber

Field

ExamineeNumber

Name

※

English

Exam Subjects

WrittenExamina-

tion

OralExamina-

tion

Program /Field

Name


(Attach an identical photograph.)

(4 x 3 cm)

Name

Cut

her

e

(4 x 3 cm)

(Attach an identical photograph.)

Cut

her

e

Photo

Exam Subjects

Master's Program

Program /Field

Field

Desktop Admission Ticket


※

○ ○ ○

Headshot with no hats, takenwithin the last three months

Headshot with no hats, takenwithin the last three months

<Guidelines for the Completion>

• Attach your photographs and enteryour name and field.

• Cut out along the lines.


Photo

筑波太郎筑波太郎筑波太郎

Please do not fillin this field.


Please do not fillin this field.


(Joint Master’s Program in International Development and Peace through Sport)

Name Taro Tsukuba Research Field and Supervisor

Sport and Gender, Race, Ethnicity

Satoshi Shimizu

Title

Write the background, purpose, method and expected result of study within 600 words. Refer to the list of the research

fields and supervisor.

○○○○○○○○○○○○○○○○○○○○○○○○○・・・・・・・・・・・・・・・・

○○○○○○○○○○○○○○○○○○○○○○○○○・・・・・・・・・・・・・・・・

Attaching a handwritten or printed document is allowed in case of having difficulty in typing.

Examinee Number

※

Research Plan


Example: Fill out this form in English.

受験番号

※

英語外部検定試験スコア貼付用紙

TOEIC Listening & Reading Test Official Score Certificate, TOEFL Test Taker Score Report/Examinee Score Report or IELTS (Academic Module)

Official Test Report Form

スポーツ国際開発学共同専攻 Joint Master’s Program in International Development and Peace through Sport

提出書類（提出する書類の□にレ印を付してください。） Document to be submitted (Check the appropriate box)

☑ ＴＯＥＩＣ（Ｌ＆Ｒ）公式認定証 (TOEIC Listening & Reading Test Official Score Certificate)

□ ＴＯＥＦＬ受験者用控えスコア (TOEFL Test Taker Score Report / Examinee Score Report)

□ ＩＥＬＴＳ公式成績証明書（IELTS (Academic Module) Official Test Report Form）

スコア貼付用箇所

（左側の枠線に合わせて貼り、右側の端部分は折り返してください。） Attach the Original document here.

(Attach it along the line on the left-hand side of the frame and fold it

so as not to exceed the line on the right-hand side of the frame.)

【注意事項】１．公式認定証または受験者用控えスコアのコピー、TOEIC SW Test 及び TOEIC Bridge

Testの公式認定証、TOEIC Institutional Program(IP) Score Report及び、TOEFL Institutional Test Score Report の提出は認めません。

２．TOEIC Listening & Reading Test 公式認定証、TOEFL 受験者用控えスコア、及びIELTS公式成績証明書は、スポーツ国際開発学共同専攻入学試験実施日から過去２年以内に受験したものが有効です。

３．提出された原本は返却しません。また、提出済スコアの差替えは認めません。

[Note] 1. You are not allowed to submit a copy of TOEIC Listening & Reading Test Official

Score Certificate, TOEFL Test Taker Score Report / Examinee Score Report or IELTS (Academic Module) Official Test Report Form, the Official Score Certificate of TOEIC SW Test or TOEIC Bridge Test, TOEIC Institutional Program (IP) Score Report, and TOEFL Institutional Test Score Report.

2. Only the TOEIC Listening & Reading Test Official Score Certificate, TOEFL Test Taker Score Report/ Examinee Score Report or IELTS (Academic Module) Official Test Report Form of the test within the past two years from the examination date of Joint Master’s Program in International Development and Peace through Sport are valid.

3. We will not return the submitted original document. Also, we do not allow you to replace the submitted score with the other scores.


Example

受験番号Examinee Number

※

研究歴証明書Certificate of Research Activities

国籍 (Nationality) ： ○○○○

氏名 ( Name )： ○○○○

生年月日 ( Date of Birth)： ○○○○／○／○

上記の者は、下記のとおり研究歴を有することを証明する。

This is to certify that the above person engaged in the research activities as follows.

記

在籍した機関、部局名及び身分

(Status and Institution Attended)

研究期間

(Duration of Research)

年月日から年月日まで ( 年か月間） From : to : ＝

( Day ) ( Month ) ( Year ) ( Day ) ( Month ) ( Year ) (Years) (Months)

研究題目及び研究内容

(Title and Outline of Research)

指導教員職・氏名

(Name and Position of Supervisor)

年月日 (Date) ：署名

(Signature) ：氏名

(Name) ：職名（注）

(Title＊) ：印

機関名

(Institution)：所在地

(Address of Institution)：

(注) 証明者は、機関の長等（例えば、学長又は学部長等）とします。

(＊The title of the certifier should be equivalent to representative of organization such as President, Dean, Director, etc)

様式 (外国人出願者用 )

Form (for foreign applicants)

Example

Foreign applicants who have completed university education in a country which has less than 16 years of school education curriculum up to the level of university graduation, have or will have conducted research for a sufficient period of time (generally one year or more) as a research student or researcher at a university, inter-university research institute, or other similar research institutes inside or outside Japan, and will be 22 years of age or older must submit this certificate authorized by the director of their institute.

Foreign students who have enrolled in University of Tsukuba Graduate School or National Institute of Fitness and Sports in Kanoya as a research student may submit a Certificate of Enrollment for Research Students designated by the University or the Institute instead of this certificate.


Address Sheet #1 1. Please do not fill in the fields marked with ※.2. The address sheets will be used to send out acceptance

letters and enrollment documents to the successful applicants.Enter the mailing address and name clearly in block letters.(This applies only to those who reside in Japan)

3. If you enter the name and address of a person other than the applicant, enter the applicant’s name in the box しかく below.

Program

Master's Program

Joint Master’s Program in International Development and Peace through Sport

Name 筑波太郎

Examinee Number ※

茨城県つくば市天久保５丁目３番地

○○○アパート B 棟３０５室

筑波太郎殿

※

○○県□□市△△１丁目１番地 1 号

○ ○ ○ ○ 殿

※

Please do not fill in the fields marked with ※.


筑波太郎


Write your name here only if you are not the recipient of the letter.


※ 国費私費

※

郵外有職者

Graduate Admissions 2021 List of Application Documents Joint Master’s Program in International Development and Peace through Sport Name 筑波太郎

Note: Make sure to mark “○” in the “Check” columns for documents to be submitted. Your application may not be accepted unless all the required documents are submitted.

Documents Check Required for Remarks

[Joint Master’s Program designated forms]

Application Form ○ All applicants

Curriculum Vitae ○ All applicants Excluding foreign applicants

Curriculum Vitae for Foreign Applicants All foreign applicants

Employment Record All applicants who have employment history

Admission Ticket for Examination / Photo Card / Desktop Admission Ticket

○ All applicants Please do not write in the fields marked with

※.

Research Plan ○ All applicants

TOEIC Listening & Reading Test Official Score Certificate, TOEFL Test Taker Score Report / Examinee Score Report or IELTS (Academic Module) Official Test Report Form

○ All applicants

Certificate of Research Activities Foreign applicants who meet the conditions

Address Sheet #1 ○ All applicants For sending out acceptance letters and other documents from University of Tsukuba or National Institute of Fitness and Sports in Kanoya

List of Application Documents ○ All applicants

Address Sheet #2 ○ All applicants Use this sheet for sending the application documents

Examination Fee (“Certificate of postal transfer payment” or “Receipt of examination fee” of JPY 30,000)

○ All applicants Attach to the specified column of the Application Form. Not required for government-sponsored foreign students

[Certificates and other documents to be prepared by applicants] (Expected) Graduation Certificate

○ All applicants

Degree Certificate ○

1. Applicants who have graduated from foreign universities

2. Applicants who would obtain a qualification for application from the National Institution for Academic Degrees and University Evaluation

Academic Transcript ○ All applicants

Letter of Approval for Taking the Entrance Examination (Format of your choice, A4 size)

Applicants who currently attend a university or graduate school

Not required for students who will graduate or complete in March 2021

Applicants who currently work for a government agency, school, or company

Not required for part-time workers

Certificate of Government-Sponsored Foreign Student

Foreign applicants who meet the conditions

Reply Envelope (with a JPY 374 postage stamp attached)

○ All applicants

This will be used to send you admission ticket for examination

受付月日 ※

月日受付者 ※ 点検者 ※

※欄は記入しないでください。Please do not fill in the fields marked with ※.

受験番号 ※

Example: Write your name either in English or Japanese.

(Address Sheet #2)

速達

3 0 5 8 5 7 4

(Express Mail Service)

（〒○○○－○○○○）

　茨城県つくば市天久保５丁目３番地○○○アパートB棟３０５室

Address

茨城県つくば市天王台一

一

一

Name 筑　　波　　太　　郎

Exp

ress

Mai

l S

ervi

ce (

Ap

pli

cati

on

Do

cum

ents

En

clo

sed

)

Jap

anProgram

筑波大学

体育芸術エリア支援室

スポーツ国際開発学共同専攻

Note 1: Fill out the same information as in the Application Form.Note 2: Attach this Address Sheet to a K2 size envelope and submit by mail or by hand.

書

留

速

達（

出

願

書

類

在

中）

御中

大学院教務


Japan:

Registered

Express Mail

Overseas:

Express Mail

(Address Sheet #2)速達

8 9 1 2 3 9 3

(Express Mail Service)

Japa

n

鹿屋体育大学

鹿児島県鹿屋市白水町一番地

書

留

速

達（

出

願

書

類

在

中）

御中

Expr

ess

Mai

l Ser

vice

(App

licat

ion

Doc

umen

ts E

nclo

sed)

Note 1: Fill out the same information as in the Application Form.Note 2: Attach this Address Sheet to a K2 size envelope and submit by mail or by hand.

教務課入試係

Program スポーツ国際開発学共同専攻

Name 筑　　波　　太　　郎

Address

（〒○○○－○○○○）

　茨城県つくば市天久保５丁目３番地○○○アパートB棟３０５室


Japan:

Registered

Express Mail

Overseas:

Express Mail