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file://C:\DOCUME~1\ADMINI~1\LOCALS~1\Temp\V6DFCATO.htmPage 1 of 119/11/2552Login: (fro) Quota in Mailbox : 358.7MB Limit 1464.8MB (24.5%) 24.5% 100%วันที่: Wed, 18 Nov 2009 15:20:06 +0900จาก: "Akane YOSHIDA (KIT)" ถึง: ses@jim.kit.ac.jpชื่อเรื่อง: Student Exchange Program AY 2010 (From KIT)สวนประกอบ:2 Query on Exchange Program AY2010.pdf application/pdf 38.40 KB3 Application Form_KIT.pdf application/pdf 521.47 KBDear exchange program counterparts,Greetings from Kyoto!Thank you for your devoted assistance for ourstudent exchange program.I am Ms. Akane Yoshida of KIT International Affairs,and today I am writing to inform you of our schedulefor student exchange in AY 2010.Please find attached file for details.Should you have any questions or concerns, pleasefeel free to contact me.Sincerely yours,Akane Yoshida(Ms.)STUDENT EXCHANGE SERVICESINTERNATIONAL AFFIRSKYOTO INSTITUTE OF TECHNOLOGYaddress: Matsugasaki, Sakyo-ku, Kyoto 606-8585 JAPANe-mail: ab7131f@jim.kit.ac.jpTel: +81-75-724-7126Fax: +81-75-724-7710

To exchange program counterparts in KIT partner institutions;Re: Short-Term Exchange Program AY 2010Greetings from Kyoto Institute of Technology.I would like to express our sincere appreciation for your kind support of our exchange program.Today I am writing to inform you of minor changes in our application form. Attached to this letter,please find the instruction concerning applicant names. This was added to Form A. The purpose ofthis change is to assist us with registering student names accurately. Thank you in advance for yourunderstanding.Furthermore, if you are planning to send your students to KIT as exchange students during the2010 Japanese Academic Year (from April 2010 to March 2011), please contact the coordinator ofKIT to let him/her know the number of students, the expected length of stay and when and howlong they want to come. It would be appreciated if you could provide us with this information nolater than December 1st, 2009.Also, please note the application deadlines below:-For admission in April 2010 (Spring semester):Application for Admission: must reach us no later than December 11th, 2009-For admission in October 2010 (Fall semester):Application for Admission: must reach us no later than June 18th, 2010If you would like to send your students in any other month, please note that the deadline forapplications is 3 months prior the admission date.Accommodations cannot be guaranteed for applications submitted after the dates indicatedabove.Application forms are available on our website at:http://www.kokusai.kit.ac.jp/english/category1/shortterm_abroad/index.htmlFor exchange program details, please contact the KIT exchange program coordinator or KITInternational Affairs.Contact:Student Exchange ServicesInternational AffairsKyoto Institute of TechnologyEmail: ab7131f@jim.kit.ac.jp

Application formsfor Short-term Exchange Programat KYOTO INSTITUTE OF TECHNOLOGYApplication materials should be sent in a single package containing all the followingdocuments:1. Application for Admission (Form A)(Completed in clear block letters. A passport photo should be pasted on the first page.)2. Questionnaire for Application for Certificate of Eligibility (Form B)3. Application for KIT International House (Marikouji Kaikan) (Form C) (If applicant desire to live in a dormitory for international students, please submit thisapplication. Admission will be decided based on room availability.)4. Recommendation Letter (Form D)(Must be signed by the dean or the head of department in which the exchange student is currentlyenrolled.)5. Recommendation Letter (Free Form)(Preferably from a professor or professional person who can verify the applicant’s suitability andmotivation for enrolling in KIT.)6. Health Questionnaire (Form E)7. Academic Transcript8. Certificate of Enrollment(which certifies that the applicant is registered as a regular student at home institution.)9. Photocopy of Passport(Personal details page. If unavailable at the time of application, submit reason and predicted date ofsubmission.)10. 4 copies of the same ID photo(Width 3cm x height 4cm. Front view, no hat, upper half of body, plain background. Photos are mustbe of high quality.)Should you have any questions or concerns, please do not hesitate to contact us.Contact:Student Exchange ServicesInternational AffairsKyoto Institute of TechnologyMatsugasaki, Sakyo-ku, Kyoto 606-8585 JAPANTEL: +81-75-724-7131FAX: +81-75-724-7710Email: ses@jim.kit.ac.jp

INSTRUCTIONS:1) Type or write in Roman block letters.2) Write numbers in Arabic numerals.3) Write years in the Anno Domini system.4) Do not abbreviate proper nouns.1Kyoto Institute of TechnologyApplication for AdmissionName in full, in native script (same as in your passport) (Family name) (First name) (All other names)Name in full, in Roman block letters (same as in your passport) (Form A) (Family name) (First name) (All other names)Name in Chinese characters, if applicable ____________________________Note: Your name will be officially registered as written above. Spell it exactly as it appears in your passport.KIT follows ward office policy on Chinese character-use in registration. If you are from a country where Chinesecharacters are in official use, the official KIT registration of your name will use these characters.2 Nationality 3. Date of birth 4. Sex Male Female / / Age Day Month Year5 Present status at home institution:i) Name of the home institution and department________________________________________________________________________________ii) academic program enrolled and school year (at the time of application)(Check one)□ Undergraduate Program Date of Enrollment: _______________________□ Master’s Program□ Doctoral Program ________ year Date of expected graduation: ____________________iii) Major 6 Present address and phone numberPaste yourphotohere.-Write your nameon the back of it.-Must be takenwithin the past 6months.-Size 4 x 3 cm. Phone: 7Permanent address and phone number Phone: 8.E-mail address ____________________________________________________(An e-mail address that can be used before you come to Japan, during your stay in Japan and after you return home is preferred.)

9 Person to be notified in applicant’s home country in case of emergencyi) Name in full (underline family name): ii) Address and phone number: iii) Occupation:iv) Relation to applicant 10. Educational background:PrimaryEducationName and Address of SchoolNameLocationYear and Monthof Entrance andCompletionFrom,To,Period ofschooling QualificationYearsandmonthsLowerSecondaryEducationNameLocationFromTo,,YearsandmonthsUpperSecondaryEducationNameLocationFromTo,,YearsandmonthsHigherEducation(Undergraduatelevel)NameLocationFromTo,,YearsandmonthsHigherEducation(Graduate level)NameLocationFromTo,,YearsandmonthsYearsTotal years of educationandmonthsNotes:1. Do not include kindergarten or nursery school education.2. Include extra-curricular activities and additional university preparatory schooling under secondary education.3. Where applicant has passed a qualifying examination for admission to a university, explain in the space marked *.4. If you require additional space, you may attach separate sheets. When attaching separate sheets, you must put your full nameand nationality on each sheet.

11. Employment Record:Begin with the most recent employment, if applicable.Name and Address of OrganizationPeriod ofEmploymentfromtofromtoPositionType of Work12Language proficiency:Circle a proficiency level. (Key to proficiency levels: 4 – Excellent, 3 – Good, 2 – Fair, 1 – Poor)Reading Writing Speaking ListeningJapanese 4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1English 4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1Other languages studied and/or spoken4 3 2 1 4 3 2 1 4 3 2 1 4 3 2 14 3 2 1 4 3 2 1 4 3 2 1 4 3 2 1I hereby apply for Kyoto Institute of Technology (KIT) as an Exchange Student based on theagreement between my home institution and KIT and pledge to observe the following articles while Istudy at KIT:(i) To refrain from violating any of the regulations of KIT, and to do my best in my studies in orderto achieve the aims of the exchange program;(ii) To accept responsibility for payment of any debts I may incur in Japan.Date of application:Applicant's signature:Applicant's name in Roman block letters:---------------------------------------------------------------------------------------------------------------------------------------------13. Recommendation of Coordinator of Exchange ProgramNameSignature Date

Questionnaire for Application for Certificate of Eligibility (Form B)Issue of a Certificate of Eligibility, mandatory to a Japanese visa, requires completion of thefollowing questionnaire. False, misleading, incorrect or incomplete information will result inunfavorable treatment at the Immigration Bureau in Japan.1. NameFamily nameGiven namesName in Chinese character,if applicable:2. Nationality 3. Sex Male Female4. Date of Birth5. Place of BirthYear Month Day6. Marital Status Married Single 7. Current town/city of residence8. Passport No. Date of expirationYear Month Day9. Accompanying persons, if any Yes No10. Place applying for Japanese visa (city in your country)11. Past entry into/ stay in Japan Yes, ___________time(s)(Most recent stay in Japan: from ______________ to _______________)12. Criminal record (in Japan or overseas) Yes (Details: No) No13. Family in Japan (Father, Mother, Spouse, Son, Daughter, Brother, Sister or others)and/or any co-residentsRelationship Name Date of birth NationalityResiding withapplicantor notPlace ofemployment / schoolStatus ofresidence14. Total period of education(from elementary school to last institution of education)15. Date of expected graduation (from your home institution) Year Month Day16. Method of financial support while in JapanA. Average anticipated monthly support and method of payment (circle if applicable)(1) Money you bring with you: ______________ yen(2) Money which will be sent from abroad: ___________ yen(3) Money which someone brings you from abroad: ___________ yen(4) Money from guarantor in Japan supports you: ____________ yen(5) Scholarship:______________ yen(6) Other: _____________ yenOrganization providing scholarship:Foreign governmentRegional bodyI hereby declare that the information given above is true and correct.Japanese governmentPublic corporationOther ( )B. Benefactor (If you circled (2), (3) or (4) in answer to above question, who supports you financially?)Name:Address:Occupation (Name of employer):Annual income: _______________ yenRelationship to applicant:Phone:Phone:yearsSignature of applicant_______________________________Date________________________

Form INTERNATIONAL HOUSE KYOTO INSTITUTE OF TECHNOLOGY To: The DirectorInternational HouseKyoto Institute of TechnologyAPPLICATION FOR ADMISSION Signature of Applicant(Form C)Exchange Student Date: year month dayIn accordance with the Regulations of International House Kyoto Institute of Technology Ihereby apply for the admission to the House Male Name of Applicant S e x Female Date of Birth year month day Nationality Occupation and Position Home Address TEL University Institution Departmentand Status in JapanKyoto Institute of Technology Type of Room desired single researcher couple researcher family researcher single student couple student family student Period of stay at KIT From year month day through year month day Period desired at From year month day through year month dayInternational House Accompanying Family Name Date of birth Sex Family relationship Occupation

(Form C)Exchange StudentForm To: The DirectorInternational HouseKyoto Institute of Technology PLEDGE Date: year month day Name Signature Since I and my family am are admitted to stay at International House Kyoto Institute ofTechnology I and my family hereby pledge to observe faithfully the Rules and Regulations of theHouse

To: The DirectorInternational HouseKyoto Institute of Technology LETTER OF GUARANTEEGuarantor's Address Name(Form C)Exchange Student Date: year month day, I hereby assume all responsibility forname of resident in the case of any default offinancial obligations caused by his/her accident or disease concerning the rent the compensationfor any loss or damage to the facilities equipment furnishings or other itemsprovidedhereinafter referred to as facilities and the cost of restoring the facilities to their originalcondition attributed to the above mentioned or his/her family at International House KyotoInstitute of Technology

Kyoto Institute of TechnologyRecommendation LetterForm DTo the President of Kyoto Institute of Technology,I hereby recommendas a candidate ofthe student exchange program between our institution and KIT. I certify thathis/her academic capability, financial status, health and conduct are more thanadequate for the successful completion of this program.Date / /InstitutionTitleName( B l o c k L e t t e r s )Signature

Kyoto Institute of TechnologyHEALTH QUESTIONNAIREForm ENOTE: All information offered below will be kept confidential and will not affect ouradmission decision in any way. (This information is collected and filed with youradmission application but is not examined until your admission is finalized.)1. Clinical history:Circle the diseases below which you have contracted and where applicable, fill in theapproximate age you were when diagnosed.a. Tuberculosis ( 結 核 性 疾 患 ) Age: ( )b. Asthma ( 気 管 支 喘 息 ) Age: ( )c. Heart disease ( 心 疾 患 ) Age: ( )d. Other ( ) Age: ( )Please give details of any illness, injury, or operation you have had over the past threeyears. (use opposite side if necessary)2. Present status:Do you have the physical and mental stamina necessary to complete this exchangeprogram?( YES. / NO. )If you answered NO, please write the reasons for your concern.3. Personal informationName: Sex: M ・ FDate of birth:Nationality: