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/policy/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.


*You can send a pre-application request to a maximum of two preferred supervisors.

(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】
Name of school or employment at present【Required】
*If you are Chinese, please write the name of your current school or employer in both English and Chinese.
(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 Supervisor list and select your preferred supervisor. You can select up to two supervisors. 【Required】
Name of Supervisor 1
Name of Supervisor 2
(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)
*Please provide details of your two most recent employment records, including the names of the employers, the countries where the employers are located, the positions held, and the periods of employment.
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 the research field of your preferred supervisor. 【Required】
* If you have selected two supervisors, please write a research plan for each supervisor.

Research plan:

Research plan:
(16) Language ability other than your native language. 【Required】




(Overall score:    , Writing score:    )
*The TOEFL iBT test can be taken in three approved ways officially: test at a test center, test on paper or test at home.
 KUT accepts all three options
(Overall score:    , Writing score:    )

*This test is only for Chinese applicants

*This test is only for Chinese applicants

 Year /   Month /    Day )


  Level:  
(17) If you are applying for scholarship/financial assistance from another institution, or if you have already received such scholarship/assistance, please provide the name and type of scholarship/financial assistance, the period of receipt, and whether concurrent receipt is permitted.
1.




 / 
 / 



2.




 / 
 / 



(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 preferred SSP supervisor(s) via this online pre-application form. You can send a pre-application request up to two preferred supervisors during a given enrollment period. When you have obtained the permission from supervisor(s), please print the form, sign at the bottom and post this along with the other formal application documents.

(Declaration and Agreement)
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, and scholarships already paid as decided by KUT.

Applicant's signature (hand-writing):  

Date submitted:
Year / / Month Day