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APPLICATIONAPPLICATIONFORCERTIFICATEOF*Pleaseattachtwosameidenticalphotographs(4×3cm,recentlytaken,fullface)withpaper(Indicatethefulllegalnamethatwillappearinyourローマ字Roman 姓 名 漢 Kanji,if 云姓 名 Sex[]male]生年月日DateofBirthYear Month PlaceofBirthJinzhou [√]未婚single[]既婚Passport(1)Number発行年月日DateofIssue Month5Day有効期限DateofExpiration Month DayIssuingAuthorityMPSExit&Entry同伴者の有無AccompanyingPersons,if 過去の出入国暦PastEntryinto/StayinJapan[ time(s)[√]直近の出入国暦ThelatestentrytoJapanFrom monthdayToyear day[√][]Yes )[√]在日家族（父・母・配偶者・子など）FamilyinJapanFather,Mother,SpouseSon,DaughterPleaseindicateRelationship,Name,Age,Nationality,ResidencewithApplicantorNot,Occupation,StatusofResidence(PeriodofStay).大学院(博士)中央大学での所属学部・課程Faculty/CourseatChuo法学(Law) 経済学(Economics) 政治学(Politics) 商学(Commercial)経営学(Management)□文学(Literature)□ 歴史学(History)□心理学(Psychology)□教育学(Education)□ 総合政策(PolicyStudies)□理工学(ScienceandEngineering□その他UniversityofShanghaiforScienceand修学年数Totalperiodofeducation(fromelementaryschooltolastinstitutionof 年卒業または卒業見込み年月日Dateofgraduationorexpected年6月日滞在費の支弁方法等Methodofsupporttomeettheexpenseswhilein 支弁方法及び月平均支弁額Methodofsupportandanamountofsupportpermonth(average) 円外国からの送金remittancefrom 60円(奨学金 円 氏名 住所addressJinzhou 電話番号職業 勤務先の名称placeofemploymentxishanPrimary 年収(現地通貨)annualincomeinlocal 単位currencyunit学生氏名Nameof 原籍機関Home UniversityofShanghaiforScienceandPleaseInorderforaCertificateofEligibilityforaStatusofResidencetobeissuedbytheImmigrationBureau,JapaneseMinistryofJustice,youmustsubmitcompleteandaccurateinformationregardingyoursourcesoffinancialsupport.Youarerequiredtosubmitcurrentevidencethatyouwillhaveatleast\100,000permonthfortheentirelengthoftimeyouplantostudyatChuoUniversity.Besuretoattachverificationofthefinancialstatementbymeansofabankstatementindicatingsavingbalance,abankremittance,acopyofabankbookwhichindicatesaproofofremittanceoracertificateofremittance,anofficialletterfromthescholarshipfoundationindicatingtheamountanddurationofthescholarship,otherofficialevidenceofcashavailableandtransferable.ChuoUniversitywillnotapplyfortheofEligibilityforyouifyoudon’tattachthe---留学費用の支弁者ResourcesforeducationalandlivingexpensesinJapan[√]個人Personal:Ifyou,amemberofyourfamily,orotherindividualwillprovidethefundsforyoureducationallivingexpenses,thefollowingoathmustbe 何文刚 (nameofthesponsor),herebysignthisoathtotakeresponsibilityforthelivingexpensesduringthestayinJapanof 何云舒(nameofthestudent).Iherebysubmitabankremittancedocumentoracopyofabankwhichindicatesaproofofremittanceoracertificateofremittance. (Waivedforexchangestudent.)Living 10 permonth Methodofpayment: Signatureofthesponsor: Relationshiptothestudent:[]Myself[√]Other(Pleasespecify:father []Ifyouaresponsoredbythegovernment,agency,privategrantorscholarship,youmustcompletethefollowingfinancialstatement.NameoftheAmountofthescholarshippermonthDurationofthescholarshipIcertifythattheaboveinformationistrueandcompl