Online Pre-Application Request Form

Online Pre-Application Request Form for Special Scholarship Program
(SSP)


After inputting your information, please click the ‘Preview’ button to go to the confirmation page.

Note: please be sure to input information for all 【Required】 items.

Your personal information will be treated properly in accordance with KUT personal information protection policy, which is based on personal information protection laws, and it will never be used for any other purpose. For the full details of that policy, visit
https://www.kochi-tech.ac.jp/english/privacy.html

IMPORTANT NOTE: *Incomplete applications will not be considered.
【Required】

When do you wish to start the program?
Have you ever applied for SSP before?
*If your answer is Yes, when did you apply
Upload your recent photo.


*Only one pre-application request should be sent to the leader of a project during a given enrollment period.

(1) Name【Required】
*Write your SURNAME (followed by your first name) in CAPITAL letters here.
*If your are Chinese,write your name in both English and Chinese.
(2) Nationality 【Required】
(3) Date of birth【Required】
Year / Month / Day
(4) Age (at time of enrolment)【Required】
(5) Present occupation (e.g. masters' student, instructor)【Required】
*If your are Chinese,write your name in both English and Chinese.
Name of school or employment at present【Required】
(6) E-mail address 1【Required】
E-mail address 2(*Optional)
(7) Present mailing address【Required】
Postal code【Required】
Country【Required】
Phone【Required】
(8) Refer to the SSP project list and select the title of your preferred project and the name of the project leader. 【Required】
Name of project leader:
Project title:
(9) Educational background【Required】
*Please enter below all the schools that you have been enrolled in, including the schools in which you are now registered.
(A) Elementary School

School name:    City, Country: 

 / 
 / 

years and months

(B) Lower Secondary School

School name:    City, Country: 

 / 
 / 

years and months

(C) Upper Secondary School

School name:    City, Country: 

 / 
 / 

years and months

(D) Undergraduate Level

School name:    City, Country: 
*If you are Chinese, write in both English &Chinese

 / 
 / 

years and months

(E) Graduate Level

School name:    City, Country: 
*If you are Chinese, write in both English &Chinese

 / 
 / 

years and months

(F) Level

School name:    City, Country: 
*If you are Chinese, write in both English &Chinese

 / 
 / 

years and months

Total years of schooling described above
(10) Employment record (if applicable) beginning with the most recent employment
*Please enter below all the schools that you have been enrolled in, including the schools in which you are now registered.
1.



 / 
 / 


2.



 / 
 / 


(11) List of publications (Provide the titles of books or papers, including graduation theses, with the publisher's name and date of publication. Write a summary, if possible.)【Required】
(12) Academic record: Average grade (CGPA, average grade)


*Please write the grades that you received and the maximum possible score. (e.g. CGPA 3.0 / 4.0)
(13) Academic honours and prizes, if any.
(14) Write a summary of your master’s thesis below. If you are still working towards your master’s degree, provide a written description of the content of your master’s thesis and of the progress of the research at this point. 【Required】
(15) Write a brief research plan based on your preferred SSP project. 【Required】
(16) Language ability other than your native language.

  
Score:       Test Date:  

Japanese proficiency test level:     Test Date:  
(17) If you are applying for another institution’s scholarship, or if you have already received another institution’s scholarship, please give the name of the scholarship and its term.


(18) If you are applying to another university, give the details in the space below.
(19) Have you ever visited Japan?【Required】

*Purpose of stay (e.g. study at school, internship, work):
(20) Have you ever lived abroad?【Required】

From  month / year to / month / year
*Purpose of stay (e.g. study at school, internship, work):
(21) What is your plan after completing the doctoral program at KUT?【Required】
Return to your current occupation

Join an educational / research institute in your country

Work in a business enterprise in your country

Join an educational / research institute in Japan

Work in a business enterprise in Japan

Other  

Send your completed pre-application request to the leader of your preferred SSP project via this online pre-application form. Only one pre-application request should be sent to the leader of a project during a given enrollment period. When you have obtained the permission of the project leader, please print the form, sign at the bottom and post this along with the other formal application documents.

  1. Missing or incomplete required documents will result in the rejection of my application.
  2. Any false declaration, false information, or incomplete information on the application form or other application documents, including but not limited to omission of information regarding educational background, will result in the rejection of my admission or the cancellation of my acceptance by the university. If such a misrepresentation is detected after my enrolment, I will accept any disciplinary actions, such as expulsion from the university or reimbursement of exempted tuition fees, as decided by KUT.

Applicant’s signature (hand-written): 

Date submitted: 
Year / / Month Day