The Mission of Asahi University
The mission of Asahi University is foster individuals who are rich in sociality and creativity, which are two important elements
to open up the international society in the future, and rich in universal human intelligence common to all people.
■ About Sociality
The idea of co-existence of human beings faces many problems to be solved, such as a problem of global resource and
environment, a labor problem in the aging society, a problem of international economy in advanced countries, and problem
of social economy in developing countries. To deal with such problems and to promote prosperity and happiness of human
being, Asahi University aims to foster such individuals who have international sense and sociality, and respect harmony.
■ About Creativity
Thanks to the dramatic development of science and technology, the human being has obtained material wealth, but this
development of science and technology must contribute to the formation of well-round character as well. To harmonize
the progress of advanced science and the formation of well-round character, the human being needs to use the creative
wisdom.
To attain this goal, Asahi University promotes specialized and comprehensive education and researches with the interdisciplinary cooperation of natural science, human and social science, and other arts.
■ About Human Intelligence
As we face the age of highly advanced industrial and information society, our style of living and values has been drastically
changing. While we enjoy the sound development of science and technology, we must also control the runaway of such
development. In this respect, Asahi University strives to foster new human intelligence to boost humanity as universal ideal
to all mankind, to establish individuality, and to construct a harmonious international future society in which human rights
and freedom are respected.
Asahi University’
s Mission and Goal
Asahi University respects the meanings of the Fundamental Law of Education and the School Education Law, and aims at the
following targets in accordance with the provisions of the Laws.
1) Doing educational research on the theory and application of general education, special arts, and sciences, and fostering
human resources with intellectual and moral culture.
2) In quest of knowledge widely all over the world, aiming at international exchanges of education and scientific research
and attaining the purpose of advanced education, thus making improvement in arts, sciences, and culture and contributing to the
development of society.
About Personal Information Protection
■ Outline
We fully realize the importance of personal information in the highly telecommunication society. We will follow the laws
and norms applicable to protect relevant personal information, and we will handle such information duly and appropriately.
■ Definition of Personal Information
Personal Information is defined in Article 2 of the Japanese Act on the Protection of Personal Information.
■ Using Personal Information
We will use personal information that you submit according to the applicant requirements only for the purposes
of: conducting the entrance examination, admission decision, admission procedure, preparatory study and trend
analysis in the entrance examination in our university.
But we sometimes provide personal information of applicants, accepted students and enrolled students to their
respective former school officials, such as teachers in their former high schools, vocational schools or Japaneselanguage schools by their request for counseling on the choice of college. If there is any objection to this, please
contact us at the location below.
■ Disclosure of Results of Entrance Examinations
We cannot disclose personal information involved in results of entrance examinations in principle. If do so, it will not be
beneficial to our university operations.
■ Contact Location
If you have any question concerning this, please contact us at the following division:
Admission and Public Relation,
Asahi University
1851, Hozumi, Mizuho City, Gifu Prefecture 501-0296
TEL 058-329-1088 FAX 058-329-1089
Outline of the 2017
Starting from the entrance examination in 2016, based on the
original one-year study term which is“One-year course”, the
study term is newly added to one year and a half which is
“One-year-and-a-half course”
.
“One-year course”is two-semester system with the first semester
and the second semester. The course is started from April and
completed in March of the next year, or it is started from
September and completed in September of the next year.
“One-year-and-a-half course”is three-semester system with the
first semester, the second semester and the third semester. The
course is started from April and completed in September of the
next year, or it is started from September and completed in March
of the third year.
In addition, after the entrance of school, the course can be
changed according to the grades and other conditions of the
students on school days.
Admissions Process
Admissions Process
1
Purpose of Japanese and Culture Course
Founded in 2001, the Asahi University Japanese and Culture Course aims to teach enough Japanese language to
international students who desire to study at our university or other universities and graduate schools in Japan.
This course offers a variety of selective courses such as “Japanese Studies” and “Basic Education” as well as
a compulsory course “Japanese Language.” Through these courses, international students can improve understanding of Japanese culture and society to have a fulfilling life in Japan.
International students who have completed transfer to our university or other national and private universities and
graduate schools.
2
Number of student enrollment and schedule from application to enrollment
The number of student enrollment is 60
※ However, give priority to admitting students entering school in April.
Term
April Enrollment
Period of Application
October 7, 2016 (Fri.) ∼November 4, 2016 (Fri.)
Screening
Announcement of
Successful Applicants
November 15, 2016 (Tues.)
Enrollment Deadline
December 2, 2016 (Fri.)
Entrance Ceremony
Early April, 2017
Term
September Enrollment
Period of Application
April 27, 2017 (Thu.) ∼May 24, 2017 (Wed.)
Screening
ᶱ
[Applicants in Japan] Documents, Interview <Applicants will be notified
individually> [Applicants from abroad]Documents
[Applicants in Japan]Documents, Interview <Applicants will be notified
individually> [Applicants from abroad]Documents
Announcement of
Successful Applicants
June 9, 2017 (Fri.)
Enrollment Deadline
June 28, 2017 (Wed.)
Entrance Ceremony
Middle September, 2017
1
Applicant Requirements
Applicants must meet the following requirements (1) , (2) , (3) .
Those who are 18 years of age or more and have completed a 12-year school education course outside
（1）
Japan (including those who are near completion by March 31, 2017 for April enrollment and by 31 August,
2017 for September enrollment) or equivalent, as recognized by the Minister of Education, Culture,
Sports, Science and Technology, Japan.
Application Procedures
Application Procedures
Those who have entered Japan having their passports, or a certification issued by their government’s
（2）
diplomatic offices and can acquire College Student status.
We expect you to have a Japanese capability of at least JLPT N５(level４).
（3）
2
Other Important Information
（1）Applicants must inform us about your application record of the past for Certificate of Eligibility to Immigration Bureau.
（2）The application documents must be issued within 3 months prior to the first date of application period.
（3）We do not accept any applications except during the application period.
（4）We cannot accept any applications with uncompleted documents.
（5）When any fraud or false is found in your application documents at a later date, your admission of
entrance will be cancelled.
（6）The submitted application documents will not be returned for whatever reason.
（7）Applicants may be requested to submit additional documents if necessary.
（8）You cannot apply to our courses if you were enrolled in another institution of Japanese language
education within Japan for more than one year.
3
Application Documents
（1）Documents to be prepared by the applicant
Document
Remarks
Application for admission
(university-specified form)
Please fill out in the applicant’s own handwriting.
Japanese translation must be accompanied when the document is not filled in Japanese.
Be sure to attach your photo.
Japanese Learning Background
(university-specified form)
Attach a copy of a Japanese capability of at least JLPT N5 (level 4).
(Be capable to certify the grades, results and other aspects of the qualification exams
for Japanese level)
Final school of graduate (high
school or higher educational
institution, etc.) Diploma or
Graduation Certificate (original),
or High School Graduation
Letter
A Japanese translation accredited by the public organization must also be
accompanied.
For Chinese applicants, certificated document issued by a Chinese notary office is required.
● Note: Submit a graduation certificate from the university the applicant
graduated from, or a graduation letter that states when you are
expected to graduate.
4
Final school of graduate (high
school or higher educational
institution, etc.) Transcript
There must be stated all credits and values for each grade.
A Japanese translation accredited by the public organization must also be accompanied.
For Chinese applicants, a certificated document issued by a Chinese notary office
is required.
● Note: Submit an academic transcript from the university the applicant
graduated from, or an academic transcript that states when you are
expected to graduate.
5
Health Certificate
(university-specified form)
6
Declaration Note for
Authorization of Resident
Eligibility Grant Application
(university-specified form)
Please fill out in the applicant’s own handwriting.
Please fill out in Japanese.
Please fill out without any errors; the University will make application on behalf of you
according to the documents you submit. If you have a passport, submit a copy of it.
7
Photos of Applicant (five)
They must be taken within 3 months before the application date (4 cm by 3 cm)
Upper front body, without hat, against plain background
Write your name and nationality on the back.
1
2
3
ᶲ
Application Procedures
（2）
Documents to be prepared by Guarantor
・The Ministry of Justice abolished the guarantor system in April 1997, however, we request a guarantor
for each applicant same as before.
・The requirements for a guarantor are as below:
① A guarantor should be a father or a mother in principle. A guarantor must be a person who can assume all
responsibilities for the personal conducts and financial obligations of a student while enrolled at Asahi University
Japanese Language and Culture Course.
② A guarantor can be an adult relative or a friend who supports himself/herself when he or she can pursue the
responsibilities mentioned above.
③ It does not matter whether the guarantor lives in Japan or not.
And it is acceptable that a person doubles as a guarantor and a sponsor.
Document
1
2
Remarks
Pledge and Letter of Guarantee
(Letter of Guarantee of student registration)
(university-specified form)
Please sign and seal the letter after filling out in the guarantor’s own handwriting.
Proof of residence
Submit documentary evidence supporting the guarantor’s residence.
Submit either one of the following documents which is applicable for the guarantor:
①For a guarantor who is
Japanese and lives in Japan
Resident Card
②For a guarantor who is
non-Japanese and lives in Japan
Residence Card and Copy of Residence Card (two sides)
③For a guarantor who does
NOT live in Japan
Copy of Family Registration with the address
For Chinese applicants, copy and submit all the pages of Family Registration.
（3）Documents to be prepared by bearer of expenses
① When the applicant’s parents or family members will send money for school and living expenses from outside Japan
Document
Remarks
Pledge Written by the Sponsor
(University-specified form)
Please make out in sponsor’s (payer’s) own handwriting.
Japanese translation must be accompanied when the document is not filled
in Japanese.
2
Certificate of Bank Balance
Submit a bank certificate balance in sponsor’s (payer’s) own name, with the
amount available in school and living expenses. (The original of certificate
of deposit and duplicate of the receipt need to be submitted for China’s
admission application.)
3
Certificate of Employment or
Vocational Certificate
Submit an Employment Certificate indicating the location of the company
and the name of the representative.
If you are a company owner or proprietor, please submit a certificate indicating the
sponsor (payer) and company names, for example “a copy of the registration.”
4
Salary Certificate
Submit documentary evidence supporting sponsor’s (payer’s) personal income.
5
Documentary evidence
supporting a parent-child
relationship or kinship
Submit documentary evidence supporting the relationship between the
sponsor (payer) and the applicant.
For Chinese applicants, copy and submit all pages of Notarization of kinship
relation and Family Registration.
1
② When a Japan resident will pay the school and living expenses for the student
Document
1
2
ᶳ
Remarks
Pledge Written by the Sponsor
(university-specified form)
Please sign and seal after filling out in sponsor’s own handwriting.
Japanese translation must be accompanied when the document is not filled
in Japanese.
Documentary Evidence
Supporting Annual Income of
the Sponsor for Expenses
Submit one of following documents:
Certificate of Municipal &
Prefectural Inhabitants Tax
Must state the amount of income and the number of dependent relatives
Tax Payment Certificate
issued by the tax authorities
(No.1) and (No.2)
Document
Remarks
1
Certificate of Bank Balance
Submit a certificate of bank balance in applicant’s own name, with the
amount of available in school and living expenses.
2
Salary Certificate or
Tax payment Certificate
Submit documentary evidence supporting the applicant’s personal income.
3
Certificate related
Scholarship Benefits
When you receive a scholarship, submit documentary evidence supporting
the amount of money and the period of payment.
Application Procedures
③ If the applicant will pay the school and living expenses by him or herself
（4）Others
The university will apply "Certificate of Eligibility for a Status of Residence" to Nagoya Regional Immigration.
Bureau on behalf of successful applicants. Please be informed that we will submit some of your application
documents for the above application if necessary.
We have no responsibility if your "Certificate of Eligibility for a Status of Residence" is not issued by the Ministry
of Justice, which is the responsible authorities.
4
Application Fee:
20,000yen
(Please send money after all application documents have been prepared.)
（1）
Remittances within Japan
With our specified transfer form filled out completely, transfer the application fee from your convenient financial
institution no later than the application deadline.
The fee charged for cash transfer should be borne by each applicant.
① Receive back the bank receipt for application fee and the cash transfer notification of the application fee, and
then confirm the receipt stamp of the bank on each of them.
②Detach the cash transfer notification of the application fee, and paste it onto the reverse of the application.
③ Keep the bank receipt for application fee for your proof (No need to submit).
（2）
Remittances from outside of Japan
① Transfer the application fee of 20,000 yen (Japanese Yen) to a designated account under the name of the
applicant. The fee charged for the cash transfer should be borne by each applicant. We will pay the fee charged
at a bank in Japan for the cash transfer from each applicant.
② Paste a copy of the transfer certification of application fee stamped by on the reverse of the application.
③ Keep the receipt for application fee as your proof. (No need to submit)
（3）
Application Fee transfer account
Transfer to
: The Ogaki Kyoritsu Bank, Hozumi Branch
(Address
: 632-2 Beppu, Mizuho, Gifu. 501-0222 JAPAN)
Deposit Item
: Ordinary deposit
Account-number
: 86596
The Recipient's
: Asahi University educational foundation
Account Name
SWIFT code
: OGAKJPJT
（4）
The application fee of 20,000yen is non-refundable.
ᶴ
Selection／ Enrollment
5
How to Submit your Application
First, ensure that application documents have been completed. Next, transfer the application fee to our designated
account and enclose all the application documents (prepared by an applicant, guarantor and sponsor) in an envelope,
and mail it (need to be delivered by the deadline) or bring it to the Admission and Public Relations, Asahi University in
person.
（1）By mail
① If posting in Japan, send it by recorded delivery.
② If posting out of Japan, send it by Express mail Service (EMS).
* We will not hold responsibility for problems with mail delivery.
* Be sure to keep copies of documents you submit with you.
Direct bringing in
（2）
The application will be accepted at the Admission and Public Relation as follows:
Monday to Friday 9:00∼16:00
Saturday 9:00∼11:30
Closed on Sundays, public holidays.
6
Where to Submit your Application
Admission and Public Relation, Asahi University
1851 Hozumi, Mizuho-city, Gifu Prefecture 501-0296
Selection
1
How to Select
Selection will be done on the basis of application documents. An interview will be held for applicants in Japan.
2
Announcement of Successful Applicants
We will notify you of your acceptance or non-acceptance into the Course by written document to be
mailed to applicant.
We cannot answer any inquires, except for the above, such as telephone.
Enrollment
Accepted applicants should submit required documents, pay tuition and fees, and complete the enrollment procedures
according to the posted "enrollment guidance" by the enrollment deadline mentioned below.
1
Enrollment Deadline
Each enrollment deadline in April and September is set out in the “enrollment information”, which will be delivered
to accepted students.
2
Required Documents
2 documents to confirm the eligibility to stay in Japan
………… 1 of each
（1）A copy of Passport
（2）A copy of resident card (two sides)
※ Applicants living in Japan should submit these required documents no later than the enrollment deadline.
In case of any changes in your residential status, period of stay, and address after submitting the above
document, you should resubmit renewals as soon as possible.
When you applying from outside of Japan, take the necessary procedures soon after your entry to Japan
and submit the above 3 documents no later than the entrance ceremony day.
ᴲ
Enrollment
3
Tuition and Fees
（1）
Tuition and Fees
①“One-year Course”
Term
Payment Period
Expenses Items
Enrollment
(April/September)
Second Term
Total
Enrollment Period
(Students Enrolled in April) :
September
(Students Enrolled in
September) : April
-
School
Expenses
Admission Fee
100,000yen
-
100,000yen
Tuition
225,000yen
225,000yen
450,000yen
Other Costs
Student Insurance Fee
-
3,500yen
Total
328,500yen
3,500yen
225,000yen
553,500yen
※Teaching-materials expense is not included in the tuition fee.
②“One-year-and-a-half Course”
Term
Payment Period
Expenses Items
Enrollment
(April/September)
Second Term
Third Term
Total
Enrollment Period
(Students Enrolled in April) :
September
(Students Enrolled in
September) : April
(Students Enrolled in April ):
April
(Students Enrolled in
September) : September
-
School
Expenses
Admission Fee
100,000yen
-
-
100,000yen
Tuition
225,000yen
225,000yen
225,000yen
675,000yen
Other Costs
Student Insurance Fee
1,750yen
5,250yen
226,750yen
780,250yen
Total
3,500yen
328,500yen
225,000yen
※Teaching-materials expense is not included in the tuition fee.
（2）
How to pay Tuition and Fees
①Remittance in Japan
With our specified transfer form filled out completely, transfer the application fee from your convenient
financial institution no later than the enrollment deadline.
The fee charged for the cash transfer should be borne by each applicant.
②Remittance from outside of Japan
Remit the school expenses and fees (328,500 yen) to our designated account under the name of the applicant
no later than the date of the enrollment deadline.
The fee charged for cash transfer should be borne by each applicant. We will pay the fee charged at a bank in
Japan for the cash transfer from each applicant.
③Tuition and fees transfer account
Transfer to
: The Ogaki Kyoritsu Bank, Hozumi Branch
(Adress
: 632-2 Beppu, Mizuho, Gifu. 501-0222 JAPAN)
Deposit Item
: Ordinary deposit
Account-number
: 86596
The Recipient's : Asahi University educational foundation
Account Name
SWIFT code
: OGAKJPJT
4
Other Important Information
We cannot accept uncompleted documents.
（1）
When any fraud or false is found in your enrollment documents at a later date, your admission of entrance will be
（2）
cancelled.
In the case where you don't finish all your enrollment procedures after the enrollment deadline, you are regarded as
（3）
having withdrawn from the admission into our University.
The tuition and fees are non-refundable except as follows: Your Certificate of Eligibility is not issued by the Japanese
（4）
authorities or you are not permitted to leave your country.
Any delay of your enrollment procedures should be informed us during the enrollment period.
（5）
We cannot accept any delay unless you inform us of the reason before the enrollment deadline.
ᴳ
Entry into Japan with
"Certificate of Eligibility for a Status of Residence"
Entry into Japan with
"Certificate of Eligibility for a Status of Residence"
You need to have a "Certificate of Eligibility for a Status of Residence" and a "Visa" to enter Japan for the purpose of
study. We will file applications for "Certificate of Eligibility for a Status of Residence" which is needed to obtain a "visa"
at the Nagoya Regional Immigration Bureau on behalf of successful applicants. When you don't have a passport, you
should get one according to the process of your country soon after you are notified of your acceptance into our Course.
Each applicant already living in Japan should pursue the necessary procedures to change the status of residence, the
period of stay, or the address, if necessary.
1
Process Chart from Application to Entrance into Japan
screening
will be
a
Send the authorization of resident eligibility to the applicants
The status
the
* Date of Arrival in Japan
New students must arrive in Japan before the following date respectively; otherwise they will not have sufficient days of
attendance required for regular examinations.
April enrollment: April 30
September enrollment: October 31
ᶷ
1
Living Guide
Living Guide
Scholarship
Asahi University establishes a scholarship for the students in Japanese Language and Culture Course.
By screening students who are in good personalities and achieved excellent academic records at the end of their first
term, we award a scholarship to eligibles of monthly 50,000yen for 6 months.
The number of awardable students is up to 5.
2
Living expenses
In the metropolitan areas of Tokyo, Osaka and Nagoya, the cost of living is very high and reaches about 100,000 yen
to 130,000 yen per month including housing. On the other hand, it goes down to around 80,000 yen in Mizuho-city
where Asahi University located. You should take this into consideration when preparing your living fund in school.
3
Housing
We take on lease an private apartment building for students of Asahi University Japanese Language and Culture
Course.
Mark "Yes" on the item of your application form (for admission) when you want to lease a room.
●Asahi University Foreign Student Dormitory (1 student per room in principle)
Monthly rent : Approx. 28,000 ∼ 30,000 yen (excluding light, fuel and water expenses)
4
Medical-Expenses Support
（1）
National Health Insurance (compulsory for every student. Subscribe at a public office of your residence.)
This is a medical care insurance to cover medical expenses to take a medical treatment without financial burden
when you suffer from illness or injury. All foreigners who stay in Japan more than one year have to subscribe to the
National Health Insurance.
You need to pay a premium when you subscribe, and your charge will be reduced to 30% of medical expenses
when you receive medical services.
Once you join the National Health Insurance, you can benefit from the medical expenses supports mentioned
below.
Medical Fee Support (Asahi University)
（2）
In our university, there are the 3 medical institutions: the University Hospital, the University Murakami Memorial
Hospital, and the PDI Gifu Dental Clinic. When you suffer from illness or injury and pay medical fees for your
treatment in our attached hospitals, we will support all the expense you paid for a health insurance treatment.
5
Part-time Employment
International students are allowed to work up to 28 hours a week (within 8 hours a day during a long vacation) by
permission of the authorities. Students who want to work should contact the Educational Affair 2 for advice.
Asahi University Japanese and Culture Courses guide students to concentrate on their schoolwork without part-time
employment for the first half year.
Before leaving your country, make sure that you have sufficient funds available in school plus living expenses.
ᶸ
ஓట᝙ᑤӌᝁ᮷ᵋµ
ᴥ´ ጥᴦ
ᄾछ͏˨Ɂஓట᝙ᑤӌɥ఍ȬɞȦȻɥᜳ஥ȺȠɞం᭒
A Copy of a Japanese capability of at least JLPT N5 (level4)
ఊጶҋᡵ‫ޙ‬ಇᴥᯚኄଡ଼ᑎൡᩜᴦ
Final school of graduate (high school or higher
educational institution, etc.)
ఊጶҋᡵ‫ޙ‬ಇᴥᯚኄଡ଼ᑎൡᩜᴦ
Final school of graduate (high school or higher
educational institution, etc.)
ఊጶҋᡵ‫ޙ‬ಇᴥᯚኄଡ଼ᑎൡᩜᴦ
Final school of graduate (high school or
higher educational institution, etc.)
ఊጶҋᡵ‫ޙ‬ಇᴥᯚኄଡ଼ᑎൡᩜᴦ
Final school of graduate (high school or higher educational institution, etc.)
ఊጶҋᡵ‫ޙ‬ಇᴥᯚኄଡ଼ᑎൡᩜᴦ
Final school of graduate (high school or higher
educational institution, etc.)
ఊጶҋᡵ‫ޙ‬ಇᴥᯚኄଡ଼ᑎൡᩜᴦ
Final school of graduate (high school or
higher educational institution, etc.)
าᴦ‫ޙ۾‬ɥԤഈɑȲɂԤഈ᛻ᣅɒɁᐐɂǾ‫ޙ۾‬Ɂ਽᎝ᜳ஥ంɕ૬ҋȪȹȢȳȨȗǿ
Note: Submit an academic transcript from the university the applicant graduated from,
or an academic transcript that states when you are expected to graduate.
Pledge and Letter of Guarantee (Letter of Guarantee of student registration)
住民票
Resident Card
在留カードの両面の写し
A copy of resident card (two sides)
Family Registration
（中国の場合は存款証明
（原本）
及び存単
（コピー）
）
(The original of certificate of deposit and duplicate of
the receipt need to be submitted for China’
s admission application.)
（＋ ）
（＋ ）
given
·®Ⴁ‫ޙ‬ႆҝᇼо‫࢑ޙ‬ఖɽ˂ʃȾȷȗȹᴥᝉछඊȾDzԱɥᜤоȬɞȦȻᴦ
Entrance Course (Circle the appropriate one.)
ᴮࢳɽ˂ʃǽǽǽǽǽǽǽᴮࢳԡɽ˂ʃ
One-year Course
One-year-and-a-half Course
¸®
Educational Background
入学及び卒業年月日
Name and Address
of School
Officially Required Year and Month and Day of
Years of Schooling
Entering and Leaving
Major Subject
Diploma or Degree
Received or Expected
(From)
Year Month Day
(Name)
Elementary
Education
(yrs)
(Location)
(To)
Year Month Day
(Name)
(From)
Year Month Day
Elementary
School
Secondary
Education
(yrs)
Lower and
Upper
Secondary
School
(Location)
(To)
Year Month Day
(Name)
(From)
Year Month Day
(yrs)
(Location)
(To)
Year Month Day
(Name)
(From)
Year Month Day
Higher
Education
(yrs)
(Location)
(To)
Year Month Day
(Name)
(From)
Year Month Day
Undergraduate
Level
(yrs)
(Location)
(Total of the schooling years mentioned above)
その他
日本語学習機関等
Other,
Japanese
Language
Schools etc.
(To)
Year Month Day
(yrs)
(From)
Year Month Day
(Name)
(yrs)
(Location)
(To)
Year Month Day
(Name)
(From)
Year Month Day
(yrs)
(Location)
(To)
Year Month Day
※上欄に書ききれない場合には、適当な用紙に記入して貼付すること。※卒業見込の場合は、卒業年月日欄に「見込」
と記入すること
※ Please attach a separate sheet if you need additional space.
※
month and year.
¹®
Employment Record
(Name and Address of Organization)
(Period of Employment)
(Position)
(Type of Work)
From
To
From
To
From
To
±°®
Family Background
(Name)
(Relationship) (Age)
(Father)
(Mother)
(Spouse)
±±®
Military Service
Date of Entry
(date)
Duty to be completed on or about
(date)
Others
±²®
How did you learn about Asahi University?
(Occupation)
(Address)
±³® あなたはどうして朝日大学留学生別科で日本語を勉強しようと思いましたか。 留学目的を明確に記入してください。
Why did you decide to study Japanese at Asahi University Japanese Language and Culture Course?
Please make an entry of your studying abroad purpose definitely.
±´®
Next stage of your education after the course, (if any)
Graduate School
College or University
College or University
Others
±µ®
Person to be notified in applicant's home country, in case of emergency
Name in Full
Present Address
Telephone Number or Fax Number
Occupation
Relationship
±¶®
Would you like to get a room in an apartment for foreign students of Asahi University during your stay in school?
Circle the appropriate one.
Yes
No
I hereby declare, upon my honor, the above is true and correct statement.
Date of Application
Applicant's Name
Applicant's Signature
ஓ ట
᝙
‫ ޙ‬᏿ ධ
Japanese Learning Background
日本語教育に携わる教員に作成を依頼し、
願書に同封してください。
Ask your Japanese-language teacher to complete this form, and attach it to your application.
志願者氏名をアルファベットで記入してください。
applicant's
姓 Last Name
名 First Name
漢字表記がある者は記入してください。
Enter the name in Chinese characters, if applicable.
Last Name
姓
First Name
名
＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊＊
以下は指導教員が記入してください。
この書類は、志願者の言語能力を示す重要な書類です。志願者の言語能力を正確かつ厳密に査定し、
ご記入下さい。
All items below must be completed by your Japanese language teacher.
The teacher must acknowledge that this form is critical for us to determine your Japanese language proficiency.
You make sure to assess and complete it accurately and properly.
指導教員氏名 Japanese language teacher
職業（身分） Occupation (position)
志願者が日本語教育を受けた学校名
School name where the applicant was educated
所在地
Location
日本語の総授業時間数及び日本語教育を受けた期間
Total hours and period the applicant is educated
時間
年
月
日
hours
year
month
day
日本語能力について、該当する評価を○で囲んでください。
applicant's
（1）極めて優れている
Excellent
（2）優れている
Very Good
∼
年
月
日
year
month
day
ge proficiency:
（3）良い
（4）平均的
Good
Fair
（5）劣る
Poor
※日本語教育機関の修了証明書、成績証明書等を添付してください。
※Please attach documentary evidence issued by the Japanese language educational institute, for example a certificate
for completing and an academic transcript.
〈Teacher to be notified〉
〈指導教員の連絡先〉
在住国名
Country
郵便番号
Postcode
住 所
Address
電話番号
Phone Number
F A X
Fax Number
日 付
Date
署 名
Signature
印 seal
ϧ
࣐
ᜳ
஥
ం
HEALTH CERTIFICATE
Sex
Name of Applicant
(Family Name)
(First Name)
Date of Birth
(Month)
(Middle Name)
Nationality
(Day)
(Year)
Present Address
Date of Examination
Measurements
身長
(Month)
Age
(Day)
体重
Height
(Year)
Weight
cm
視力
裸眼
矯正
色覚異常の有無
聴力
Eye Sight
Without Glasses
Correction
Color Blindness
Hearing
Right
Left
kg
Right
Left
脈拍数
/min
Pulse Rate /min
胸部X線検査
施行日
Chest X-ray
Date
血圧
m/Hg∼
Blood Pressure
(Month)
(Day)
(Year)
所見
Findings
検尿
施行日
Urinalysis
Date
(Month)
蛋白質
血尿
Protein
Occult Blood
(Day)
(Year)
ブドウ糖
Glucose
鏡検所見
Microscopic
総括的健康状態
（⃝印をつけること）
General state of physical condition (Circle the appropriate one)
優
良
可
不良
Excellent
Good
Fair
Poor
今後引き続き又はさらに精密な検査あるいは治療を必要とする場合は必要事項を記入すること。
If there is any need for further and/or follow-up observation and/or treatment, specify.
家族病歴に特記すべき事項があれば記入すること。
If there is any significant matter in family medical history, specify.
備考
Remarks
医師署名
Signature of Physician
医師名
（タイプ又は活字体）
Name (Type or Print)
医療機関名及び所在地
Name and Address of Medical Facility
診断日
Date of Report
(Month)
(Day)
(Year)
m/Hg
٣ Ⴁ ៾ ಐ ᝓ ް ᜳ ஥ ం ̬ ͇ ႑ ᝭ Ⱦ Ρ ɞ႑ ֖ ᇝ
Declaration Note for Authorization of Resident Eligibility Grant Application
この書類を元に、名古屋入国管理局に在留資格認定証明書の交付申請を行います。
虚偽のないよう、記入してください。
According to the form, the university will apply for Authorization of Resident Eligibility to Nagoya
Regional Immigration Bureau on behalf of the student. Complete it correctly without any errors.
1.
2.
氏名
姓
名
Name
Last Name
First Name
3. 生年月日
国籍
年
Birth of Date
Nationality
月
日
year/month/day
4.
性別
Sex
6.
男
女
Male
Female
配偶者
Material Status
8.
有
無
Married
Single
5. 出生地
Birth of Place
7. 現在の居住地
Residence
現在の状況（あてはまる項目にチェックし、詳細を記入してください。）
Current Status (Tick the applicable boxes and enter details)
□
学生
Student
学校名：
□
在職
Employee
職業：
□
その他
Others
（ School name:
）
会社名：
（ Occupation:
）
（ Company name:
（
）
）
※職業については、
アルバイトは除きます。
※Part-time job is not included in occupation.
9.
最終学歴
Highest Level of Education
高校
High School
□
（
専門学校
Vocational school
□
（
大学
学校名： School name:
）
その他
学校名： School name:
）
学校名： School name:
）□
University （
学校名： School name:
）□
（
Others
10. 有効な旅券
Do you have a
valid passport?
有
□ Yes
番号：
（ Number:
有効期限：
）
（ Effective period:
年 月 日
）
year/month/day
無
□ No
※有と答えた方は、旅券のすべてのページのコピーを添付してください。
※
11. 日本への過去出入国歴
Have you previously
entered Japan?
有
□ Yes
無
□ No
回数：
（ Number of times:
直近の出入国歴：
（ most recently:
your passport.
回
）
年 月 日
∼
year/month/day
∼
年 月 日
year/month/day
）
在留カード番号
Residence Card number
特別永住者証明書番号
Special Permanent Resident Certificate number
When I am admitted to your university, I will pledge myself to observe the code of the
school and other regulations, and make the payment of school expenses and tuition.
I will submit to any reprimand if I break these regulations and never complain about it.
seal
seal
seal
seal to
be used
‫ ࠜ ۦ‬в ា ಅ ᶨ᣸Үвាಅᶩ
Letter of Guarantee (Letter of Guarantee of student registration)
seal
志願者氏名
Applicant’
s Name
Postcode