Academic Year 2019 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number

Form A Application Form * Do not fill out this section.

The program applying for

The name of the course

applying for

Examination Category

Program Course Domain Examination date Examination Types

Master’s Program

Doctoral Program

Environmental and

Information Studies

(Yokohama Campus)

Urban Life Studies

(Todoroki Campus)Domain

Schedule B

[September]

Schedule C [February]

General Screening

Screening for working adults

Special Screening for international students

Validation stamp of

consent to application by

research supervisor

*1

Seal*1: Required. From the Domains and Instructors on page 3, applicants are required to

obtain a signature and validation stamp from the instructor (not marked with an

asterisk *) of the course or domain applying for.

*2: If the instructors are marked with a triangle or a diamond (those who will teach until

the middle of each program year) in the Domains and Instructors on page 3,

applicants are required to obtain a signature and a validation stamp from the

instructor who will subsequently take over up to the final year.

*3: The staff marked with an asterisk (*) in the Domains and instructors on page 3 are

assistant research supervisors. Applicants cannot apply only by obtaining an

approval from “*: Assistant research supervisors.” Applicants are required to

obtain a signature and a validation stamp from “research supervisors not

market with an asterisk (*)” within the same domain.

*4: Only for the Doctoral Program: For the Doctoral Program, applicants are required

to determine an advisor.

Validation stamp of

consent to application by

the instructor who will

subsequently take over

*2

Seal

Validation stamp of

consent to application by

assistant research

supervisor

*3

Seal

Validation stamp of

consent to application by

advisor

*4

Seal

Full

Name

Katakana

Kanji

Family Name Given Name

*Please fill out using katakana or alphabets if you cannot fill out using kanji characters.

Current affiliated laboratory

* To be filled out by applicants advancing internally.Student Number

Registered

Domicile

Fill out the name of prefecture

(nationality for international students)

Gender□ Male

□ FemaleDate of Birth Born in Month 　 　　 Day　 　　, Year 19 　　　

(Age　　 　　　)

Fill out the age as of April 2, 2019.

Academic

background,

etc.

High schoolYear , Month

Graduated from

□ Graduated

UniversityYear , Month

University Faculty of　　　　　　　　　　Department of

□ Graduated

□ Expected to graduate

Graduate school Year , Month

Graduate School:

Doctoral Program (first semester) [Master's Program]:

□ Completed

□ Expected to complete

Work experience

If any, fill out the name of company, year and month of joining, the number of years in service,

etc.

Applicant

Address

Start from the name of prefecture. Please correctly fill out the name of apartment/condo.

Zip code -

Tel (Cell phone) ( ) - E-mail address @

Academic Year 2019 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number

Form B Secondary Form (Photograph Ticket)* Do not fill out this section.

Full NameKatakana <Affix a photograph here＞

1. The photograph must be taken for

identification documents (color

photo is also accepted).

2. The photograph must be taken

within three months. It must be

taken from the waist up, directly

facing the camera, and bareheaded.

3. The photograph must be four cm in

height and three cm in width without

frames.

4. Spread glue all over the surface.

5. Write down the applicant’s name

and the name of the course

applying for on the back of the

photograph.

The name of the

course applying for

Environmental and Information Studies (Yokohama Campus)

Urban Life Studies (Todoroki Campus)

The name of the

domain applying forDomain

(Affix receipts in the blank space below.)

Academic Year 2019 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number

Form C Statement of Purpose and Research Plan* Do not fill out this section.

Program Course Domain Full Name

Master’s Program

Doctoral Program

Environmental and Information Studies

(Yokohama Campus)

Urban Life Studies

(Todoroki Campus) Domain

<Read below before filling out>

Write down the reasons for applying for the graduate school and research plan using 1,500 to 2,000 characters (including figures) in total.

Be sure to contact and consult with the instructor of the domain applying for in advance prior to writing.

Use a word processor or Microsoft PowerPoint when writing.

Submit a copy after pasting if you cut and paste.

<Affix a photograph here＞

1. The photograph must be taken for

identification documents (color

photo is also accepted).

2. The photograph must be taken

within three months. It must be

taken from the waist up, directly

facing the camera, and bareheaded.

3. The photograph must be four cm in

height and three cm in width without

frames.

4. Spread glue all over the surface.

5. Write down the applicant’s name

and the name of the course

applying for on the back of the

photograph.

Form C. Continue to the back page.

Form C. Continued from the front page.

Intended for the applicants of the [Screening for working adults]

Academic Year 2019 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number

Form D Curriculum Vitae * Do not fill out this section.

Program Course Domain Full Name

Master’s Program

Doctoral Program

Environmental and Information Studies

(Yokohama Campus)

Urban Life Studies

(Todoroki Campus) Domain

Do you want to apply for tuition reduction and exemption?

□ Yes, □ No (Check either of the boxes.)

Era Year MonthAcademic Background

Fill out the final school enrolled and graduated (completed).

Era Year MonthProfessional Experience

Besides work experience, fill out research achievements in detail.

Please provide the publication of any research that falls under the categories provided in the margin.

Title Corresponding number for

the institution published to [Corresponding number

for the institution published to]

1. Paper (academic journal, association

journal)

2. Verbal presentation at academic

conference

3. In-house newsletter

4. In-house research group

5. Patent filings

6. Awards, etc.

Intended for the applicants of the [Screening for working adults]

/Doctoral Program: Intended for the applicants applying under the eligibility categories (6) or (7)

Academic Year 2019 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number

Form E Letter of Recommendation * Do not fill out this section.

Date:

To the President of Tokyo City University

Recommended by Seal

Affiliation

Job title

Relation with the applicant

I would like to recommend the following person as an applicant who wishes to study at the Graduate School of Environmental and Information Studies, Tokyo City University.

Applicant Name

(Date of birth) Date of birth:

The program applying for

The name of the course applying for

Master’s Program

Doctoral Program

Environmental and Information Studies (Yokohama Campus)

Urban Life Studies (Todoroki Campus)Domain

Do you want to apply for tuition reduction and exemption?

□ Yes, □ No (Check either of the boxes.)

1. Please fill out the reason for recommending the applicant, including the applicant’s major work experience and research area.

2. Please provide the publication of any research that falls under the categories provided in the margin.

TitleCorresponding number for the

institution published to [Corresponding number

for the institution published to]

1. Paper (academic journal, association

journal)

2. Verbal presentation at academic

conference

3. In-house newsletter

4. In-house research group

Intended for the applicants of Doctoral Program

Academic Year 2019 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number

Form F The Summary of Research in the Doctoral

Program (First Semester), Etc.

* Do not fill out this section.

Program Course Domain Full Name

Doctoral ProgramEnvironmental and Information Studies

(Yokohama Campus) Domain

The Summary of Research in the Doctoral Program (first semester) [Master’s Program], Etc.

Research title and

the title of the paper

Summary of the content

Books

Book Name Published by Year and date of publication

Academ

ic Papers

Paper NameName of magazine

presented toYear and date of presentation

Pu Title Institution presented to Year and date of presentation

blication of

Research

Intended for the applicants of the [Special Screening for international students]

Academic Year 2019 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number

Form G Special Screening Application Form* Do not fill out this section.

Program Course Domain Full Name

Master’s Program

Doctoral Program

Environmental and Information Studies

(Yokohama Campus) Domain

The flow of application procedure

(1) In principle, the applicant must use this form to request the Instructor for the

program that the applicant is applying for more than a month prior to the

submission of the application.

(2) The course will determine application eligibility for a special screening.

(3) If it is determined that the applicant is eligible to apply, the seal for the approval by

the course will be affixed at the bottom of this form. The instructor of the course for

which the applicant is applying will return the form to the applicant. (If not approved,

the applicant will be treated as general admission.)

(4) At the time of the submission of application, please send this form along with other

application forms.

Eligibility

Applicants who are eligible for general screening and acquire sufficient

accomplishments in the area related to the course.

* The eligibility of applicants will be determined after the advanced submission of

application by applicants upon screening by the relevant course.

*Students who are expected to graduate from TCU and graduates of TCU are

ineligible. In principle, this special screening is intended for international

students.

Screening method

Candidates are selected based on the overall performance of the

screening of the application documents and interview, including an oral

examination. However, depending on the status of enrollment, the school

may instruct candidates to provide a presentation of the research plan or

take an examination for specific subjects.

■ To be filled out by the applicant

Application schedule

□ Schedule B [September]

□ Schedule C [February]* Please check the box for the application schedule.

Special Screening

Reason for

application eligibility

(Summary)

Please fill out the summary of reasons for the application in this section and fill out the details on the reverse side. If there are any related materials, please attach

separately.

Fill out the details on the reverse side.

■ To be filled out by the courseAs a result of the determination for the course for the applicant above, the special screening will apply to the applicant for the entrance examination for the Graduate

School of Environmental and Information Studies for Academic Year 2019.

Date:

Graduate School of Environmental and Information Studies,

Tokyo City UniversityDesired instructor for the course Seal

Examination content

Program Course Domain Full Name

Master’s Program

Doctoral Program

Environmental and Information Studies

(Yokohama Campus) Domain

■ To be filled out by the applicant

Reason for application eligibility for special screening (Details)

Academic Year 2019 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number

Form H Applicant Survey Form[For International Students]

* Do not fill out this section.

[Please note that this survey form must be carefully answered and filled out entirely by the applicant in his/her own hand]

■Information about the applicantThe program/course

applying for

Graduate School of Environmental and Information Studies, Master’s Program/Doctoral Program

　　　　　 　　　　 Course: 　　　 　　　　　　 Domain

(Katakana) Last Name (　　　　 　　　　　　　　　　　　　　　) First Name (　　　　　 　　　 　　　　　　　　　　　)

Full name in kanji

Full name in Roman

characters

Date of birth Month Date , Year 19 (dominical year) Gender Male / Female

Country or region of

origin

Current resident status□Study abroad　　□Other (　　　　　　　) [Residential visa expiration: Month Date , Year (dominical year)

□Currently, I do not have any resident status because I reside outside Japan.

Date of landing

permissionMonth Date , Year (dominical year) [Port of arrival: ]

Record of stay in Japan

*Please tell us about your stay in

Japan in the past three months or

more.

*If the applicant resides outside of Japan, it is not necessary to fill out the sections for resident status and the landing permission.

However, if the applicant has lived in Japan for more than three months in the past, please provide the reason and the name of institution in the section for the record of stay in Japan.

■Family informationPlease provide information about parents, brothers and sisters, and grandparents except for yourself. If there is not enough space, please fill out the same information

on a separate sheet and attach it.

Full nameRelationship with

the applicantOccupation Place of residence

Father

Mother

■ History of learning JapaneseBe sure to fill out if the applicant is enrolled in a Japanese-language school.

Name of institutionLocation

(country, state/province, city)Duration

Number of class

hours per weekLevel

From Month , Year to Month , Year Hours per /weekBeginner, Intermediate,

Advanced

From Month , Year to Month , Year Hours per /weekBeginner, Intermediate,

Advanced

From Month , Year to Month , Year Hours per /week Beginner, Intermediate,

Advanced

■ History of learning English

Name of institutionLocation

(country, state/province, city)Duration

Number of class

hours per weekLevel

From Month , Year to Month , Year Hours per /weekBeginner, Intermediate,

Advanced

From Month , Year to Month , Year Hours per /weekBeginner, Intermediate,

Advanced

From Month , Year to Month , Year Hours per /weekBeginner, Intermediate,

Advanced

Continue to the back page.

■ Academic background and work experiencePlease start from the applicant’s elementary school, junior high school, and high school to university in chronological order.

School name,

company name, etc.

Location

(country, state/province, city)Enrollment status and duration

Graduation, completion, transfer,

expected to graduate/complete

Joined/Withdrawn

Number of years in

school/employment

From Month , Year to Month , Year years

From Month , Year to Month , Year years

From Month , Year to Month , Year years

From Month , Year to Month , Year years

From Month , Year to Month , Year years

From Month , Year to Month , Year years

From Month , Year to Month , Year years

From Month , Year to Month , Year years

Total years in school years

Total years in employment years

■ Plans for the payment of study abroad expenses

Living expenses

Monthly average　　　　JPY　　　　　　　　　　　　

Paid by and the amount

Applicant JPY　　　　　 　　　　　 , 　　Father/Mother JPY 　　　　 　　　　　　　　

Other (Full name: 　　　　　　　　Relationship: 　　　　　　　) JPY　　　　　　　　　　　　

School expenses

Amount for half year　　　　JPY　　　　　　　　　　　　

Paid by and the amount

Applicant JPY　　　　　 　　　　　　　Father / Mother JPY 　　　　 　　　　　　　　

Other (Full name: 　 　　　　　　　Relationship: 　　 　　　　　) JPY 　　　 　　　　　　　　　

Please explain how study abroad expense will be paid. *Details on money transfer, part-time job, etc.

*Please fill out details about the person who will pay for study abroad expenses in the section below if a person other than the application is paying for both or either of the expenses.

■ Person who will pay for study abroad expensesKatakana

Age

Years old

Relationship with

the applicantFull name

Current address

Tel

Fax

Occupation

(Name of employer)

Work address

Tel

Fax

[General Screening/Screening for Working Adults] Intended for applicants who are applying under the eligibility categories (7) or (8) for the Master’s Program,

applicants applying under the eligibility categories (6) or (7) for the Doctoral Program, and applicants applying under the Special Screening for International Students.

Academic Year 2019 Graduate School of Environmental and Information Studies, Tokyo City University

Form I Application Form for the Screening of the Qualification for Enrollment

Date of submission: Month Date , Year

Program applying for

(Please circle the one)Master’s Program / Doctoral Program

Entrance examination type

(Please circle the one)General entrance examination / Screening for working adults / Special screening for international students

Katakana

Full name Male / Female

Date of birth Month Date , Year (dominical year) (Age )

Admission month

and yearAdmitted in Month , Year

Course applying for Course

Desired Instructor Instructor :

School graduated from

(Last school attended)

University / School, Department of

Graduated/Completed in Month , Year (dominical year)

Current employer

Current address

Zip code

Shipping address

Zip code

□ Same as the above (Please check the box if it is the same as the current address)

Contact

information

Home ( ) 　　 　　　－

Mobile ( ) 　　 　　　－

Academic Year 2019 Graduate School of Environmental and Information Studies, Tokyo City University Identification Number

Form J Address stickers for an examination

ticket

* Do not fill out this section.

Shown below are the address stickers to mail the examination ticket after application procedure and the acceptance letter after examination.

Please fill out the address where the examinee receives the mail safely. The name must match the name of the examinee.

In addition, individual messages or assignments might be mailed before taking the examination.

□□□ -□□□□ □□□ -□□□□ □□□ -□□□□

Examinee’s name

To

Examinee’s name

To

Examinee’s name

ToAcademic Year 2019

Graduate School of Environmental and Information Studies,

Tokyo City University

Academic Year 2019

Graduate School of Environmental and Information Studies,

Tokyo City University

Academic Year 2019

Graduate School of Environmental and Information Studies,

Tokyo City University

Master’s Program

Doctoral Program

Environmental and Information Studies

Urban Life Studies

Master’s Program

Doctoral Program

Environmental and Information Studies

Urban Life Studies

Master’s Program

Doctoral Program

Environmental and Information Studies

Urban Life Studies

Domain : Domain : Domain :

* Do not fill out this section.

Identification

Number

* Do not fill out this section.

Identification

Number

* Do not fill out this section.

Identification

Number