Be sure to send your application via tracked service, such as resigtered mail (i.e. EMS, , Letter Pack)If you are unable to submit some documents by the dealine, or plan to submit documents afterwords, please include a memo
noting which documents are not included and when you plan to submit them.
(Your estimated) Submission Deadline for the extra documents
Student No. Laboratory Ext.
Adviser's Signature and Seal
N a m e
Address in Japan
(enrollment year)
Master's course Doctral course Medicine Dentisitry
Graduate school
Undergraduate
Faculty
N a m e Student Number
Family members living together in Japan only
Instruction for Completing Admission Fee Waiver Application Form (Example)
The application for Admission Fee Waiver will be used only for the screening procedure for Admission fee waiver. Indicate the truth accurately by yourself.If intentional descriptions different from the fact are found, the Admission fee waiver will be canceled even after the approval.
Fill in the situation as of April for the April enrollment and as of October for the October enrollment.
For the items marked with , encircle the appropriate items.
Fill in the column of "Reasons for Difficulty in Admission Fee Payment" including the following items.
Special circumstances
Independent livelihood financial situation
Situation of persons (living in Japan) under long-term medical treatment
Detailed situation (in Japan) of storm and flood damage, etc.
Foreign students' life situation in Japan
When you are unemployed, indicate how you cover your cost of living, the prospect of reemployment, etc.
Date of submission of application documents.
To be signed by the applicants
Attach the required documents.
Fill in the address, phone number, e-mail address that will be applicable after the application. Leave them blank if you don't know them at the time of application.
Leave the student No. blank if you don't know your new student No. at the time of application.
To be signed by adviser. Signed or sealed by proxy are not acceptable.
Please use blue or black pen only (pencil and erasable pen are not acceptable).
Student No. Laboratory Ext.
Adviser's Signature and Seal
N a m e
Address in Japan
(enrollment year)
Master's course Doctral course Medicine Dentisitry
Graduate school
Undergraduate
Faculty
Instruction for Completing Admission Fee Waiver Application Form
N a m e Student Number
Family members living together in Japan only
Occupation of family members living together in Japan
If you or family member(s) living together in Japan have the Identification booklet for the physically disabled certificate, fill in the name and level.If you or family member(s) living together in Japan are on long-term medical treatment, fill in the name and submit the most recent six months of receipt of medical treatment.
Enter the necessary items so as to copy them in the duplicate sheet. Submit the sheets without separating them.
For the items marked with , encircle the appropriate items.
Do not fill in the items inside the thick line frame. These items are the official use only.
Scholarship benefits to be received (expected to be received) during this academic year (from this April to next March).Fill in the name of the scholarship.
Foreign students paying their own tuition must fill in the information about ONLY family members living
Left-align the Student No
This is for Japanese students only
Foreign students paying their own tuition must choose 1.
Please use blue or black pen only (pencil and erasable pen are not acceptable).
Official Use Only
Official Use Only
Official Use Only
Family members (living together in Japan) enrolled in school as of April (April enrollment) and as of October (October enrollment).
This is for Japanese students only
Form A
TOHOKU UniversityDocument for Admission / Tuition Fee Waiver Application
Student No.
NAME
E
TOHOKU University Document for Admission / Tuition Fee Waiver Application
Payment Slip Attachment Sheet
Name of the income earner
Relationship with the applicant
Type of Employment
/ Full-time employee Part-time employee Other
Student No
Name
Form 1
TOHOKU University Document for Admission / Tuition Fee Waiver Application
2020 1
/ (
3
3 3
(
)
12
2021 4 2022 3
Student No.
Name
This form must be filled out by the person in charge of the employment.
Form 5
To President,
I declare the following information to be factual and accurate.
Other Other
Total Total
Income
Occupation / School
Utilities
Fill out your financial situation as of April 2021 1st semester) or October 2021 (2nd semester).
Average Living Expensesper Month
Statement of the Financial Situation
Family members living in Japan
Surname Given name
Books, school supplies(excluding tuition fee)
Transportation andCommunication
Food
Expenditure
Important The balance between income and expenditure must be even or income must be more than expenditure.
TA/RA
Indicate the financial situation in Japan (calculated in Japanese yen) accurately.
Item
Housing(include management /
maintenance fee)
Scholarship(family member)
Scholarship (applicant)
Child Care
Insurance /Medical Care
Part-time work(family member)
Daily necessities
Part-time work(applicant)
Name
Adviser's remark:PC
Self-financed / Moneybrought from home
TOHOKU University Document forAdmission/Tuition Fee Waiver Application
Student ID Number
RelationshipLiving
together/separately
(seal)
ItemAverage Income per Month
Remittances / Financialsupport from family, etc.
(Adviser's Signature
Age
Form7 To be filled out by foreign students paying their own tuition
TOHOKU University Document for Admission/Tuition Fee Waiver Application
Statement for Accommodation Situation
Indicate your accommodation type
(International House/University House) (Public Housing) (Private Apartments/Houses) (Other)
(Rent per Month)
If the applicant is living in private apartment or public housing, please submit a copy of the contract of lease.
If the applicant is sharing a room, or does not have a contract of lease for his/her accommodation, please fill out the “Conditions of Lease Contract” below.
If the applicant does not pay rent, shares the rent with roommate or pays less than the full monthly rent, please describe the situation in the “Other Information”.
Conditions of Lease Contract of your Accommodation
Address
Lessee
Relationship with Applicants
( )
Person(s) living with Lessee other than
applicant
Yes ( Name Relationship with Lessee
No
Rent per Month
Include Common Area Fee
(Applicant’s share)
Other Information
Please submit a copy of the contract of lease (photocopy).
( ) I declare the above information to be factual and accurate. (Must be signed by the person who rent the apartment)
Lessee Signature
( ) Phone No.
Student Number
NName
11 Form 11
Tohoku University Document for Admission / Tuition Fee Waiver Application
TA RA Certificate of (expected) TA/RA Payment
This is to certify the applicant’s working condition and income situation of TA/RA. Please certify the facts as stated below.
TA RA AA
20 4 1 20 9 30 6 300,000
It is not necessary to submit this form when there are other documents that certify the entire information above.
This form must be filled out by the person, faculty or the office in charge of the employment.
