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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) $~~A~fFPltm 1 OJ ooisectltfltlltim1f
For applicant part 1 Ministry ofJu~tice Government of Japan
o Please fill the yellow columns a1d put tle yeo~ circles on the apprqpri~ terms 1pound ~ if ~ yenJ IE w ~ it ~ 1T Ej3 ~~ it
APPLICATION FOR CERTIFICATE OF ELIGIBILITY
A 00 ifJ1llfpj ~ To the Director General of Regional Immigration Bureau
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40mm x 30mm the certificateshowing eligibility for theconditions provided for in 7Paragraph 1 Item 2of thesaidAct Pursuant to theprovisions ofArticle7-2of theImmigration Control andRefugee Recognition Act I hereby applyfor
1 00 ~plusmnili ~ 2 jamppf S ampp f S Month DayNationalityRegion Dateofbirth Y-eear-+-__------__---==_
~- ~- I 3 ~m FAMILY NAME Given name
4 ~) JFYcl e a~rct middotiffJopa(f5 tffi~fl 6 1lc11~0)1f~ 1f ~ Sex Mal lt-female Placeofbirth Marilal status MarrleampL-BngleI
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9 S 1t3fT01lHC I It x~ll7lltprn)O~2-1-1 ~~~~~B~yenI~xjft~
AddressinJapan
~~~ m~~~ I029-228-8056 Telephone No Ceilular phone No --------r------- shy
fj10 1~ (l )~ (2)1fWJM~amp ampp I S Passport Number Dale ofexpiration Y-ee-ear+- Month Day---__=t
11 AOOsectiyenJ (rJzO)v f1iJ~~ T0 tO) 7r~Iv_e ltt~v o) Purposeofenlry check one of Ihe followings o I r~~J 0 I r~~J 0 J r~J 0 J rX1l TsectliJiJ 0 K r~J o uyena~J
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o L rJ1~fjiyeniibJ 0 M r~B ~~J 0 L r-liJf~ (iyenilUJ) J lntra-company Transferee Business Manager Researcher (Transferee)
o N r-liJf~J 0 N rj1V1~ AXP~middot oo~~rJ 0 N rj1filSJ Researcher Engineer SpecialistinHumanities international Services Skilled l abor
o Nr~flt5WJ(-liJf~Tsecttb ~)J 0 0 rJl1TJ _ p rfjj$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
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( (corrected)
( tJ 1J
eyesight
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colordiscrimination 0 ~E (
~1flpound method of photographing o r~~ indirectlyDO directly
photograph number
t~~graphing IjZgX 1fshy jj
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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
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
--------------------------------- --------------
------------- -------------
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
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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$1~ O)fYt~1F~J a~T~ ~ mO)~~c-trP1G Express existence or nonexistence and detail of any noteworthy illness on the view ofhealth care in the university
aq I ~~I2fJT(1)~L~BC1) ~t3 tJ tsect~rchV =shy ~ ~fIEfjFjT 0 0
I attest above contents based on the results of diagnostics IjZiJX ~ jj (]
date Y M D
address 1plusmnm regtEplusmnfu) -+shy _
nameoftheinstituteorhoopital [3[ ~ r~ ~ ~ -----------+-----=name ofthe doctor andsignature or seal [3[ ~ffi 0) A ~
seal
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[NOTES] 1)Ifeyesight is not normal be sure to fill out the corrected eyesight 2) Please dont leave columns in blank In order to prevent accidental skip please fill any word
eg none
AOO~FIffiffi ~ Ib Director of Imm igrat ion Bureau
Letter of Financial Support
OOflf Nationality
~6 Name
~fF1313 Date of birth
fF Year
13 Mont h
13 Day
(~ fx) (MaleFemal e)
I 5lLdi O)t a JBcO) t O) b~ 13 OOI~ ~OO ~cmO)ffi~)[1fI~ f~ ~ i ~tO) -c rBc O) ~jO ~ ffi~ )[0)51~ sectt~t~rrt~mgFjT~ ~ ~ tl~ffi Jt)[I~-J v -C ~iEgFj ~~T o I have become a financial supporter ofthe above applicant dur ing hisher stay in J apa n and therefore I would like 0 explain the reason for support and make the following stateme nt
1 ffiJt)[ 0)5Ist~tffirrt (ffl ~1f 0) ffi )[ ~ 5 1 )t ~ttgamp affl~1f ~ 0) ~11~ -Jv _C ~yenJ 1~Bc$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
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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$1~ O)fYt~1F~J a~T~ ~ mO)~~c-trP1G Express existence or nonexistence and detail of any noteworthy illness on the view ofhealth care in the university
aq I ~~I2fJT(1)~L~BC1) ~t3 tJ tsect~rchV =shy ~ ~fIEfjFjT 0 0
I attest above contents based on the results of diagnostics IjZiJX ~ jj (]
date Y M D
address 1plusmnm regtEplusmnfu) -+shy _
nameoftheinstituteorhoopital [3[ ~ r~ ~ ~ -----------+-----=name ofthe doctor andsignature or seal [3[ ~ffi 0) A ~
seal
[~B~o)~] I 1) tJttJ~~EiJ~(b6~~j ~fmlEtJ1J~~CA L-c lttc~ V 2) -to)1t~fl~j~nCAL Jf5tO)ftvlMl-ct~ttMicrrftL ~h1~~~~CAL ~cft~n
-cftv = c iJ ~biJ6 J 5 ~ L-c lttc~v ~ctt~w$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
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( (corrected)
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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) $~~A~fFPltm 1 OJ ooisectltfltlltim1f
For applicant part 1 Ministry ofJu~tice Government of Japan
o Please fill the yellow columns a1d put tle yeo~ circles on the apprqpri~ terms 1pound ~ if ~ yenJ IE w ~ it ~ 1T Ej3 ~~ it
APPLICATION FOR CERTIFICATE OF ELIGIBILITY
A 00 ifJ1llfpj ~ To the Director General of Regional Immigration Bureau
PhotoIplusmnJAooif~ampLf~~~~$ 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
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
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( (corrected)
( tJ 1J
eyesight
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colordiscrimination 0 ~E (
~1flpound method of photographing o r~~ indirectlyDO directly
photograph number
t~~graphing IjZgX 1fshy jj
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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
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