2013-2014 CSC Application .doc

中国国家建設高水準大学公費派遣研究生受入制度出願書類Application Documents Checklist for “The Special Admission for Postgraduate Study Abroad Programby China Scholarship Council（国家建设高水平大学公派研究生项目）”発送前出願書類確認同封。Please submit a completed Application Documents Checklist along with your application documents to ensure that all necessary documentation has been submitted.必中国国家建設高水準大学公費派遣研究生受入制度募集要項提出書類確認。 Please be sure to check the documents that you are required to submit in the “The Special Admission for Postgraduate Study Abroad Program by China Scholarship Council (国家建设高水平大学公派研究生项目)”.理由出願書類不備場合、出願受付。Any uncompleted application will not be accepted without proper reason.得提出書類場合、不足書類理由欄必理由明記。但、理由認限。If applicants are not able to submit all of the required documents for compelling reasons, please explain specifically why you are not able to do so in the Reasons for Delayed Submission section at the end of this checklist. Please note that your reasons for delayed submission may not always be accepted.提出書類欄印記入。Please indicate for submitted documents with tick on the following list.志願者氏名APPLICANTS NAME志望研究科名NAME OF GRADUATE SCHOOLNo.提出書類 Required Documents所定用紙Designated FormTick 入学志願票 Application Form卒業（修了）証明書 学位取得証明書（原本）Certificate of Graduation (Diploma) & Degree Certificate (Original)在学証明書（原本） Certificate of Enrollment (Original)成績証明書（原本） Academic Transcripts (Original) 研究計画書 Research Plan語学能力関証明書Language Proficiency Certificate 推薦状（原本） Letter of Recommendation (Original)（推奨/Recommend) Copy of Passport提出書類返還依頼書 (該当者) Request Form for Return of Submitted Materials(if any)出願書類 Application Documents Checklist出願書類提出用宛名 Address Label 所定用紙欄印書類、国際上、入力記入 提出。Documents marked “*” in the Designated Form column should be downloaded from the International Admissions Office website and completed.不足書類Name of Document未提出理由 Reasons for Delayed Submission下記理由認場合。Reasons may not be deemed acceptable.1.2.3.不足書類提出時、出願書類提出用封筒貼付追加書類明記、志願者氏名志望研究科名追加書類封筒明記、国際宛郵送。 Please send an additional documents via registered mail with the applicants name, desired graduate school, and additional documents clearly written on an Address Label attached to the envelope. 受験番号 Application No. 2013 2014 年度早稲田大学大学院 入学志願票（中国国家建設高水準大学公費派遣研究生）CSC Application Form for Graduate Schools of Waseda University, 2013-2014 Admission. 志 願 者 Applicant information写真4cm3cm最近月以内撮影写真不可裏面氏名記入Paste a recent color passport sized photograph measuring 3 cm by 4cm.Name in Katakana (if any) 氏名（漢字）Name in Chinese 姓(Family) 名(First)氏名（英字）Name in English(記載通 As written on passport)国 籍生年月日NationalityDate of birth 19/ /(year / month / day) 性別 sex ： 男：Male 女：Female現住所(英字) Present Address in English(郵便番号 Postcode / Zip : ) 現住所(中文)Present Address in Chinese (郵便番号 Postcode / Zip : ) 電話 (Tel. )携帯電話E-mail address(Mobile ). 志望大学院 Desired field of study at graduate school志 望 研 究 科Graduate School専攻専門分野Department研究領域研究指導（指導教員）Research Area / Major (Name of supervisor)博士後期課程Doctoral Program外国人特別研修生Special Research Students Program( )半年 or一年half a year one year注意：1) 国際内、大学院入試出願研究指導担当教員参考、研究科、専攻、研究指導名記入。Note: Refer to the website for International Admissions Office” Graduate Admissions Application Research Supervisors fill out names of the Graduate School, Department and Major2) 入学希望印。Circle your desired program.3) 外国人特別研修生志望場合、期間（半年1年）選択。For Special Research Students program, circle a period of time (half a year of one year), . 入学希望時期 Desired period of admission 2012年 9月：September 2012 2013年 4月：April 2013注意：入学時期中国国家建設高水準大学公費派遣研究生受入制度募集要項2013年9月，2014年4月入学者用別表必参照。Note: Refer to the appendix on “The State Scholarship Study Abroad Program for Graduate Studies at the China National University of Construction by China Scholarship Council” Admissions Guide as for an enrollment period, such as September 2013 admissions or April 2014 admissions. 受験希望会場 Examination Venue Request注意：面接試験北京上海実施研究科出願場合、次。Note: Check the box below if you are applying for the graduate schools conducting the interview at either Beijing or Shanghai. 北京会場受験希望 / Request for the interview examination at the Beijing Office of Waseda University. 上海会場受験希望 / Request for the interview examination at the Shanghai Office of Waseda University. 東京会場受験希望 / Request for the interview examination at Tokyo. 学歴 Educational background注意：1) 通学全学校（小学校含）年代順記入。/ List all schools attended, including primary school, in chronological order.Note:2) 書切場合、任意用紙追記、添付。/ If you have more information to add but have run out of space on the form below, you can attachextra details on a separate sheet of paper.学校名Name of school学校所在地Location of school在学期間Period of attendance学位Degree to (year)(month)(year) (month) to (year)(month)(year) (month) to (year)(month)(year) (month) to (year)(month)(year) (month) to (year)(month)(year) (month) to (year)(month)(year) (month) to (year)(month)(year) (month) to (year)(month)(year) (month) to (year)(month)(year) (month)通算修学年数Total years education外国語学習歴（日本語含）Foreign Language Study (including Japanese language courses)外国語Foreign language履修期間Period of study (Years)履修機関Institution使用教材Language Textbooks mainly used1.年間2.年間3.年間職歴Occupational experience職場名Name of company and / or employer所在地Location勤務期間Period of employment兵役Military service etc.終了 from/to/ 未了Yet to be doneCompletedYear/MonthYear / MonthNo obligatory military service在留資格Status of residence in Japan在留資格？。Do you have the status of residence in Japan? *Please circle.YES / NO在留資格種類期限（在留資格志願者）Type & Period for a status of residence (For applicants with a Japanese residence status.)在留資格 Type for a statis of residence: （）在留期限：年 月 日 Validity till YEAR, MONTH, DAY入学後在留資格代理申請希望？（在留資格変更在留期間更新除）。Do you request for COE application by proxy?(Expect for changing a status of residence or extension period of stay in Japan)*Please circle.希望 YES / 希望 NO本入学志願票他出願書類記入内容相違，研究計画書私自身作成，入学許可場合早稲田大学規則従誓約。I certify that all the information provided on this application form and in the accompanying documents is complete and accurate, and that the research plan was written by myself, and, if admitted, I agree to comply with the rules and regulations of Waseda University.日付(Date)： 年(Year) 月(Month)日(Date)署名(Signature)： 印(Seal)推薦状Recommendation Letter FormPage1This form needs be written either in Japanese or English. If it is written in a language other than Japanese or English, a Japanese or English translation must be attached.英語日本語記入。以外言語推薦状作成場合、日本語訳英語訳一緒提出。Applicants Name:_志願者氏名 (Last) (First) (Middle) 姓 名1. How long and in what capacity have you known the applicant? 推薦者志願者関係及関係発生時期(over)2. How do you assess his/her purpose in coming to Waseda University?Please consider motivation, steadiness and intelligence.志願者本学志望目的、及動機確、持続性、学習遂行必要能力(over)3. Please write any other information or remarks that, in your estimation, are relevant to evaluating the applicants potential for graduate study.他(over)Please continue to next page. 目続 Page2Your Name: _ 推薦者氏名:(Last) (First) (Middle)Your Institution: _ 所属:Your Position: _ 役職:Address: _住所: _Tel: _電話:Do you want the applicant to have access to this recommendation letter?志願者本推薦状閲覧希望場合。 _ Yes _ NoSignature:Seal 署名:印Date (yyyy/mm/dd):_日付:TO THE RECOMMENDER: After completing this form, please place it in an envelope, seal it, and sign your name across the seal. Then return it directly to the applicant who will then send it to Waseda University along with all his/her other application documents. Thank you.記入後、厳封上志願者渡。提出書類返還依頼書Request Form for Return of Submitted Materials依頼日：年 月日 Date of Request:Year Month Date返還12月必要。予了承。Thank you for understanding to be returned submitted materials in one or two months.志願者氏名：Applicants Name 姓(Family) 名(Given & Middle)早稲田大学再発行可能書類返還一切，行。具体的公証書，成績証明書,推薦状再発行可能返還。下記返還希望書類書類再発行理由書，確認，再発行不可能早稲田大学判断書類返還行。Waseda University never returns the submitted documents which can be reissued, such as the notarized certifications (Degree/Graduation certificates), transcripts, and recommendation letters. If you wish to return submitted materials, please address the name of documents you wish to return with reasons below.返還希望書類返還希望理由 (Desired return of submitted materials and Reasons for return)： 提出書類返還希望場合，以下文章読署名。If you would like us to return any submitted materials, carefully read the statement below and provide your legal signature.提出書類返還希望。返還時紛失破損早稲田大学一切責任承知。I request the return of the materials listed below. I understand and agree that Waseda University has no responsibility for lost or damaged materials.志望研究科 Desired Graduate School志望課程 Desired degree programs電話番号 Telephone Number志願者署名： 印App