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INFORMATION SHEET
for Shinshu University Student Exchange Application in Academic Year 2015 -2016
1. General Information:
Name of University:
SHINSHU UNIVERSITY
Website of University:
http://www.shinshu-u.ac.jp/
Website for exchange student program:
http://www.shinshu-u.ac.jp/institution/suic/english/prospective/exchange-in/
Contact persons
for incoming exchange students:
Jialin Ma(Ms.)
Exchange program coordinator,
Shinshu University International Center(SUIC)
3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
E-mail Address: [email protected]
Telephone Number: +81-263-37-3360
Fax Number: +81-263-37-2181
Tomonori Sato(Mr.)
Professor,
Shinshu University International Center(SUIC)
3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
E-mail Address: [email protected]
Telephone Number: +81-263-37-3227
Fax Number: +81-263-37-3227
2. Academic Calendar:
Dates
Designated or recommended date of arrival:
Semester 1 (Spring 2015)
Semester 2 (Autumn 2015)
April 1, 2015
September 15, 2015
Date students can move into accommodation: April 1, 2015
September 15, 2015
Orientation and procedures dates:
April 1, 2015 ~ April 7, 2015
September 15 ~ September 25, 2015
Classes start ~ end:
April 8, 2015 ~ July 28, 2015
September 18, 2015 ~ January 25, 2016
Registration deadline:
April 21, 2015
October 9, 2015
Exam and End-of-program presentation period:July 29, 2015 ~ August 5, 2015
January 26, 2016 ~ February 9, 2016
Vacation (Summer / Spring):
August 7, 2015 ~ September 14, 2015
February 11, 2016 ~ March 31, 2016
Transcript offered:
*will be issued upon completion of the program.
End of September, 2015
End of March, 2016
3. Academic and Enrollment Information:
Length of the exchange period:
Enrolled student year:
Qualifications for
incoming exchange
students:
One or two semesters
No requirements, but must be enrolled as a degree-seeking student at their home university for the entire exchange
study period at Shinshu University.
Language Proficiency: For Japanese Learning: None; For Major Subjects: Fluent enough to understand classes in Japanese
Be in a good physical and mental condition, and have no health problems that may interfere with participating in the
program. To prove they are able to maintain themselves financially for the duration of their exchange in Japan. Must
Extra Qualifications:
respond to various surveys from Shinshu University.
Language for exchange students:
Japanese
Certificate requirement:
Take at least 10 credits per year (5 credits a semester), be present at the end-of-program presentation.
Visa requirements:
To apply for a student visa, students will be required to submit a Letter of Acceptance and a Certificate of Eligibility
(COE) (which will be sent to you) to the appropriate Japanese Embassy or Consulate for your area.
4. Application Procedure:
Dates
Application deadline:
For Semester 1 (Spring 2015)
September 15, 2014
For Semester 2 (Autumn 2015)
March 15, 2015
■ List of applications (to be completed by the home university contact person)
Required documents for application:
■ Application form
■ Original academic transcript (only in English or Japanese)
Notify each partner university of results &
deadline of additional required documents:
October 31, 2014
April 30, 2015
◆ 3 photos (40mmx30mm)
◆ Medical certificate (the form can be downloaded from our website)
Additional documents to be submitted later:
(The deadline is to be announced later)
◆ Insurance Application Form (the form can be downloaded from our website)
◆ Copy of passport
◆ Certificate of bank deposit
Mininum amount (Equivalent to JPY500,000 for one-semester exchange; JPY1,000,000 for one-year exchange)
◆ Evidence of language proficiency (a copy is ok) if available
5. Accomodation:
Housing Application Deadline:
To be announced in the "Application of Housing" form, which will be sent to you later.
・International house (Off Campus, Rent fee: JPY4,700/month, Other fee:JPY58,000/year)
・University apartment (Off Campus, Rent fee: JPY32,000/month, Other fee:JPY30,000/year)
Total: JPY49,200~103,500/month
Housing: JPY4,700~32,000/month
Approximate expenses:
Meals: JPY25,000~35,000/month
(The information is an estimation of the monthly
Books/Supplies:JPY2,000~3,000/month
expenditure of a reasonably economical
international student at Shinshu University.
Personal/Miscellaneous: JPY5,000~15,000/month
Expenses will vary according to personal taste and Local Transportation: JPY500~1,500/month
lifestyle.)
Insurance: JPY2,000/month
Utility Charge(gas, electricity, water): JPY10,000-15,000/month
Housing available to exchange students:
Pick-up Service:
No, but an Access Guidebook will be sent to students before coming.
6. Insurance:
Approximate cost:
We require all exchange students to purchace health and liability insurance in Japan.
Health insutrance: JPY1,500/month ; Liability insurance: JPY400/month
7. Scholarship:
How to apply:
To be announced in the Application Guidelines for exchange student program.
Amount:
JPY80,000/month
SHINSHU UNIVERSITY EXCHANGE STUDENT PROGRAM (AUTUMN 2015 - SPRING 2016)
Application Guidelines for Shinshu University Exchange Student Program
(Autumn Semester 2015 --- Spring Semester 2016)
1. Eligibility
Applicants must meet the following requirements.
(1) You must be enrolled as a degree-seeking undergraduate or postgraduate student with a Student
Exchange Agreement at one of our partner universities1 for your entire study period at Shinshu University.
(You will be registered as a special auditing student; therefore students whose main purpose is to conduct
research are not eligible for this program.)
(2) You must complete one or two semesters starting from October 2015. Students who wish to study less
than a semester (e.g. for a few weeks or for three months) are not eligible to apply. 2 To view the academic
calendar, go to the following website: http://www.shinshu-u.ac.jp/institution/suic/english/current/calendar/
(3) You must be in a good physical and mental condition and have no health problems that may interfere with
participating in the program.
(4) We require all self-financed students to provide us with documentation that proves that they are able to
maintain themselves financially for the duration of their exchange in Japan. Before acceptance,
self-financed students must send a bank statement (their own, or that of a close family member) to us
showing that they possess funding as follows:
For a one-semester exchange: the equivalent of 500,000 JPY.
For a one-year exchange: the equivalent of 1,000,000 JPY.
(5) You must respond to various surveys from Shinshu University during you study in Japan and after you
returned to your home country.
The Shinshu University Exchange Student Program is competitive. Please be advised that meeting the above
requirements does not guarantee admission into the program.
2. Selection
The selection procedure is as follows.
(1) Contact the section in charge of exchange programs at your home university and ask for details and a
deadline for submitting the required documents within your university. Next, submit the following items
together with the other required documents of your home university (if any) to the exchange program
coordinator by the designated date. The exchange student coordinator of your home university needs to
send the following items to Shinshu University International Center (from now referred to as “SUIC”) by
MARCH 15, 2015.
Items
Notes
①
List of Applicants
・
【Issued by Shinshu University】To be completed by the contact person of your home university.
②
Application Form
・【Issued by Shinshu University】To be completed by the applicant.
③
Academic Transcript
・【Issued by your home university】In English or Japanese.
*Please note that applications submitted directly by individual applicants will not be accepted.
(2) SUIC will process the received documents and then notify each partner university of results and any
additional required documents by the end of April in 2015.
The status of “exchange student” becomes null and void when a student graduates from their home university. Exchange students who wish
to pursue their postgraduate study at Shinshu University following this exchange program can prepare for it as a research student and be
exempt from tuition fees for up to one year. Please contact us for further details.
1
2
If you wish to study as an exchange student but not under this exchange program, please contact SUIC as soon as possible.
1
SHINSHU UNIVERSITY EXCHANGE STUDENT PROGRAM (AUTUMN 2015 - SPRING 2016)
(3) Each partner university needs to send any additional required documents to SUIC.
① 3 photos (40mmx30mm)
② Medical certificate (Please use the specified form)
③ Insurance application form (Please use the specified form)
④ Copy of passport
⑤ Certificate of bank deposit
⑥ Evidence of language proficiency (a copy is ok) if available
(4) SUIC will make the final decision of admission according to the documents submitted, and then begin
preparing for the students’ arrival (visa documents, accommodation arrangements, etc.).
3. Tuition Fees
Exchange students under this program are exempt from Shinshu University tuition fees, but are required to pay
tuition fees at their home universities.
4. Where to Send Application Documents and Inquiries:
Students under this exchange program will be affiliated with SUIC, and SUIC professors will be their advisers.
All application documents and inquiries should be addressed to:
Shinshu University International Center
Division of International Exchange
Tomonori Sato (Professor)
Jialin Ma (Staff)
Address: 3-1-1 Asahi, Matsumoto City, 390-8621, Nagano, Japan
Address: 3-1-1 Asahi, Matsumoto City, 390-8621, Nagano, Japan
Email: [email protected]
Email: [email protected]
Tel/Fax: +81-263-37-3227
Tel : +81-263-37-3360 Fax : +81-263-37-2181
5. Available Classes
Exchange students can take courses from the following list. It is possible that students cannot take some
classes if their Japanese language skill is not sufficient or if the class capacity has already been reached.
Except for language subjects, all subjects are taught in Japanese. Please be aware that these courses are not
offered in English. All syllabi can be found at the following website. (Japanese only)
http://campus-2.shinshu-u.ac.jp/syllabus/syllabus.dll/top
(1) Japanese-related subjects
①
Intensive Japanese Language subjects offered by SUIC (one “koma” is a class of 90 minutes)
A class: For students who do not know any Japanese or Japanese characters: 9 koma per week
B class: For students who have studied some basic Japanese: 9 koma per week
C class: For students who can communicate in Japanese but whose level is insufficient: 8 koma per week
For your reference, the following is a list of classes offered in the 2014 (current) academic year. The SUIC
Course List for 201 (with English Syllabi) is posted on the following website.
http://www.shinshu-u.ac.jp/institution/suic/english/prospective/exchange-in/
A Class
Fall Semester（Oct. – Mar.）
Spring Semester（Apr. - Sep.）
Course Title
Class Hours
Credits
Japanese; Grammar (A)
(3 koma/week)ｘ15 weeks
3
Japanese; Grammar (A)
Japanese; Conversation (A)
(3 koma/week)ｘ15 weeks
3
Japanese; Conversation (A)
Japanese; Reading/Writing (A)
(1 koma/week)ｘ15 weeks
1
Japanese; Reading/Writing (A)
Japanese; Practical Conversation (A)
(1 koma/week)ｘ15 weeks
1
Japanese; Practical Conversation (A)
Japanese; Kanji (A)
(1 koma/week)ｘ15 weeks
1
Japanese; Kanji (A)
2
Course Title
Class hours and credits
are the same as the
spring semester
SHINSHU UNIVERSITY EXCHANGE STUDENT PROGRAM (AUTUMN 2015 - SPRING 2016)
Total Credits
9
B Class
Fall Semester（Oct. – Mar.）
Spring Semester（Apr. - Sep.）
Course Title
Class Hours
Credits
Japanese; Grammar (B)
(3 koma/week)ｘ15 weeks
3
Japanese; Grammar (B)
Japanese; Conversation (B)
(3 koma/week)ｘ15 weeks
3
Japanese; Conversation (B)
Japanese; Kanji (B)
(1 koma/week)ｘ15 weeks
1
Japanese; Kanji (B)
Japanese; Reading/Writing (B)
(1 koma/week)ｘ15 weeks
1
Japanese; Reading/Writing (B)
Japanese; Practical Lesson (B)
(1 koma/week)ｘ15 weeks
1
Japanese; Practical Lesson (B)
Total Credits
Course Title
Class hours and credits are
the same as the spring
semester
9
C Class
Fall Semester（Oct. – Mar.）
Spring Semester（Apr. - Sep.）
Course Title
Class Hours
Credits
Japanese; Grammar (C)
(3 koma/week)ｘ15 weeks
3
Japanese; Grammar (C)
Japanese; Conversation (C)
(3 koma/week)ｘ15 weeks
3
Japanese; Conversation (C)
Japanese; Practical Lesson (C)
(2 koma/week)ｘ15 weeks
2
Japanese; Practical Lesson (C)
Total Credits
②
Course Title
Class hours and credits are
8
the same as the spring
semester
Japanese language and Japan study subjects offered by the School of General Education
For upper-intermediate students who want higher language skills and who want to experience and
understand Japanese culture, the Japanese language and Japanese culture classes which are offered by
the School of General Education (the organization which manages the general education curriculum for
first-year students) are also regarded as a part of Japanese-related subjects in this exchange program.
Japanese language and Japanese culture Class
Fall Semester（Oct. – Mar.）
Spring Semester（Apr. - Sep.）
Course Title
Class Hours
Credits
Reading(Japanese Language) A-Ⅰ
(1 koma/week)ｘ15 weeks
1
Reading(Japanese Language) A-Ⅱ
Reading(Japanese Language) B-Ⅰ
(1 koma/week)ｘ15 weeks
1
Reading(Japanese Language) B-Ⅱ
Writing(Japanese Language) A-Ⅰ
(1 koma/week)ｘ15 weeks
1
Writing(Japanese Language) A-Ⅱ
Writing (Japanese Language) B-Ⅰ
(1 koma/week)ｘ15 weeks
1
Writing (Japanese Language) B-Ⅱ
Listening(Japanese Language) A-Ⅰ
(1 koma/week)ｘ15 weeks
1
Listening(Japanese Language) A-Ⅱ
Listening (Japanese Language) B-Ⅰ
(1 koma/week)ｘ15 weeks
1
Listening (Japanese Language) B-Ⅱ
Conversation (Japanese Language) A-Ⅰ
(1 koma/week)ｘ15 weeks
1
Conversation (Japanese Language) A-Ⅱ
the same as the spring
Conversation (Japanese Language) B-Ⅰ
(1 koma/week)ｘ15 weeks
1
Conversation (Japanese Language) B-Ⅱ
semester
Scientific and Technical JapaneseⅠ
(1 koma/week)ｘ15 weeks
1
Scientific and Technical JapaneseⅡ
Business JapaneseⅠ
(1 koma/week)ｘ15 weeks
1
Business JapaneseⅡ
Japanese; Upper Intermediate (Grammar)Ⅰ
(1 koma/week)ｘ15 weeks
1
Japanese; Upper Intermediate (Grammar)Ⅱ
Japanese Society and PeopleⅠ
(1 koma/week)ｘ15 weeks
2
Japanese Society and PeopleⅡ
Japanese Martial Arts and Traditional CultureⅠ
(1 koma/week)ｘ15 weeks
2
Japanese Martial Arts and Traditional CultureⅡ
Total Credits
15
3
Course Title
Credit total
Class hours
Credits
Class hours and credits are
15
SHINSHU UNIVERSITY EXCHANGE STUDENT PROGRAM (AUTUMN 2015 - SPRING 2016)
(2) General Studies, Basic Science, Health Science, Freshman Seminar and Teaching Profession
subjects which are offered by the School of General Education.
(3) Major Subjects (Including Introductory Major Subjects)
Notes: Exchange students who wish to study Japanese language intensively are able to take Japanese
language classes at SUIC. Those who wish to study major subjects are able to choose classes taught in
Japanese for degree-seeking students of Shinshu University, which are offered by other faculties or divisions,
and earn credits.
Please be advised that the Faculty of Education (Nagano City), Faculty of Engineering (Nagano City), Faculty
of Agriculture (Minami-Minowa Village), and Faculty of Textile Science and Technology (Ueda City) are located
separately from Matsumoto campus, which is where all courses related to Japan and Japanese language are
offered. Because of this, you cannot register major subjects in those four faculties and courses related to Japan
and Japanese language during the same semester. If you want to study at those four faculties as an exchange
student, please contact us as soon as possible.
Some exchange students who enroll for two semesters at Shinshu University study at Matsumoto campus
during their first semester (six months), and then study at the Faculty of Education, Faculty of Engineering,
Faculty of Agriculture, or Faculty of Textile Science and Technology during their second semester. In that case,
the approved students must move out of Matsumoto City after their first semester.
① Matsumoto Campus
(SUIC/School of General Education /Faculty of
Arts /Faculty of Economics /Faculty of Science)
●Subjects related to Japan and Japanese language
offered by SUIC or the School of General
Education
●General Studies, Basic Science, Health Science,
Freshman Seminars and Teaching Profession
subjects which are offered by the School of
General Education.
●Major subjects for first-year students which are
offered by each faculty, and major subjects for
undergraduate students or graduate students
which are offered by the Faculty of Arts, Faculty of
Economics and Faculty of Science.
② Nagano - Education Campus
(Faculty of Education)
*Exchange students will not be allowed to attend classes for second-year or
above undergraduate students because of the curriculum.
●Major subjects for graduate students which are offered by the Faculty of
Education.
③ Nagano - Engineering Campus (Faculty of Engineering)
●Major subjects for second-year or above undergraduate students or graduate
students which are offered by the Faculty of Engineering
④ Minami-Minowa Campus (Faculty of Agriculture)
●Major subjects for second-year or above undergraduate students or graduate
students which are offered by the Faculty of Agriculture.
⑤ Ueda Campus
(Faculty of Textile Science and Technology)
●Major subjects for second-year or above undergraduate students or graduate
students which are offered by the Faculty of Textile Science and Technology.
For more details, please refer to the following websites.
Undergraduate:
http://www.shinshu-u.ac.jp/english/faculty/
Graduate: http://www.shinshu-u.ac.jp/english/graduate/
②
NAGOYA
名古屋
③
①
⑤
④
4
TOKYO
東 京
SHINSHU UNIVERSITY EXCHANGE STUDENT PROGRAM (AUTUMN 2015 - SPRING 2016)
6. Registration and Academic Results
Exchange students must fill in a registration form at the beginning of the semester and submit it to SUIC after
getting their advisors’ approval. Students who study at a campus other than in Matsumoto can submit the form to
the Student Affairs section of their campus.
An official academic transcript will be issued upon completion of the program. The transcript will include
course titles, grades, and the number of credits earned. Please see the sample on the last page. You are strongly
advised to consult with the person in charge of exchange programs at your home university regarding credit
transfer before applying to this program.
Please note that an official academic transcript for the 2015 Autumn Semester will be issued at the end of
March 2016, and for the 2016 Spring Semester at the end of September 2016.
7. Certificate Requirements
To complete the program, students must complete at least 10 credits per year (5 credits per semester), and
present a report in Japanese during the end-of-program presentation.
8. Accommodation
We provide several types of accommodations to exchange students including the International House and
apartments leased by Shinshu University. Because the number of rooms available at the International House is
limited, there is no guarantee that all students can be assigned to their preferred accommodation.
9. About JASSO Scholarship (Student Exchange Support Program)
The Ministry of Education, Japan (MEXT), in collaboration with the Japan Student Services Organization
(JASSO), offers scholarships under the “Student Exchange Support Program” for short-term study in Japan. The
scholarship program is intended to encourage student exchange between universities in Japan and their
overseas partner institutions, promote understanding and friendship between the countries participating, and
strengthen the internationalization and competitiveness of Japanese universities.
Students wishing to apply for a JASSO scholarship must confirm the eligibility before checking "Yes" on
question 5 of the application form (“Are you intending to apply for a JASSO scholarship?”). You can find the
details of eligibility, scholarship provisions from the application package for Shinshu University Exchange Student.
If Shinshu University Exchange Student Program is selected by JASSO as a student exchange support
program, Shinshu University will nominate candidates from the applicants who check “Yes” on question 5 of the
application form, and inform the selected students of their nomination through their home universities.
10. Information on our Exchange Student Program
Please check the following website regularly for updates.
http://www.shinshu-u.ac.jp/institution/suic/english/prospective/exchange-in/
5
SAMPLE
SHINSHU UNIVERSITY
International Center
3-1-1 Asahi, Matsumoto City, Nagano, 390-8621, JAPAN
Tel:+81-263-37-3360 Fax:+81-263-37-2181
TRANSCRIPT OF ACADEMIC RECORD
STUDENT NUMBER :
NAME :
Date of Birth :
Date of Admission :
Date of Leaving School:
ORDER NUMBER :
DATE OF ISSUE :
12REXXXX
XXXX XXXXX
May X, 1992
October 01, 2012
September 30, 2013
XXXXXX
September 30, 2013
International Center
Subjects / Course Title
SEMINAR : Hospitality for sporting events
Comparative Arguments Focused on Japanese and Chinese Cultures Seminar
Japanese Reading Ⅱ
Japanese Writing Ⅱ
Japanese LanguageⅡ(Listening & Vocabulary)
Japanese Condition (Culture and Japanese Language)
Japanese Society and people Ⅱ
Japanese; Upper Intermediate (Grammar)
Japanese Martial Arts and Traditional Culture Ⅱ
Academic Japanese 1-Ⅱ
Multi-Cultural Understanding
Scientific and Technical Japanese Ⅱ
Introductory Economics
Introduction to Japanese Economy
Seminar of Data Visualization
Business JapaneseⅠ
Listening (Japanese Language)B-Ⅰ
Reading of Economic Indicators
Finance
Year
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2012
2013
2013
2013
2013
2013
2013
2013
2013
Grade
S
A
S
S
B
S
S
A
B
B
A
S
C
A
C
A
B
A
A
Credits
2
2
1
1
1
2
1
1
1
1
1
1
2
2
2
1
1
2
4
I hereby certify that the above transcript is true and correct.
Signature:
Akahane, Masao
Director, International Center,
Shinshu University, Japan
GRADING SYSTEM
S : excellent
: 90 - 100
A : very good : 80 - 89
B : good
: 70 - 79
C : satisfactory : 60 - 69
UNITS OF CREDIT
Credit for academic work in the University is awarded in semester units.
The academic year is divided into two semesters of 15 weeks each.
One credit is granted for 45 hours of study, composed of formal teaching and student preparation.
1/1
Sheet1.Instruction _E
Application Package
for Shinshu University Exchange Student Application Form
Overview
1. This application package consists of:
• Sheet1. an instruction guide (English Version)
• Sheet2. about JASSO Scholarship (English Version)
• Sheet3. Shinshu university exchange student application form
• Sheet4. a sample of application form
2. Please type or write clearly and answer all questions completely either in Japanese or in English (Write your
signature by hand). Imcomplete form will not be accepted.
3. Besides this Application Form and Academic Transcript, some additional documents need to be submitted later.
We will inform your home university of the admission decision and the additional required documents list.
Instruction Guide
1. Personal Data
• Write all of your name(s) in English as it appears on your passport (even if the name is misspelled).
• Name in Katakana: Please write your name in Japanese Katakana.If you are not sure,please ask any Japanese teacher.
• Name in Chinese Characters(Kanji): If applicable, write your name in Chinese Characters.
2. Academic Background
• Expected Date of Graduation: Please write your expected date of graduation, taking into account academic requirements
at your home university and your exchange period at Shinshu university.
3. Language Proficiency
• If you have passed the Japanese Language Proficiency Test, please indicate the level and score that you obtained.
• If English is not your native language, please rate your English ability. If available, state the name of any internationally
recognized English language examination (e.g.,TOEFL, IELTS, TOEIC) taken, and scores obtained.
• Except Language subjects, all of the classes offered at Shinshu University are taught in Japanese. Please note that the
classes are not offered in English. After arriving at Shinshu University, students may opt to take classes at a level
determined by the result of their placement test. Students may not be allowed to attend some classes if their Japanese
language skill is not enough or the class becomes full. Please check the following website for the latest guideline of our
exchange student program. http://www.shinshu-u.ac.jp/institution/suic/prospective/exchange-in/
4. Planed Period of Enrolment at Shinshu University
• Students joining this program are required to arrive in Japan for a pre-class orientation as follows: those joining the
program in the autumn semester must arrive in Japan in late September; those joining the program in the spring semester
must arrive in Japan in early April. The student status of applicants intending to leave Shinshu University at the end of the
spring class period will be valid until late September. The student status of applicants intending to leave Shinshu University
at the end of the autumn class period will be valid until late March.
5. Study Plan at Shinshu University
• Area of study you wish to pursue at Shinshu: If you wish to take any Japanese subjects, Choose Japanese, too.
• Please note that the Faculty of Education, Faculty of Engineering, Faculty of Agriculture, and Faculty of Textile Science
and Technology are located far separately from Matsumoto campus. You cannot register major subjects in those four
faculties and courses related to Japanese language during the same semester.
• If you wish to study major at Shinshu, please select the major you wish to study at Shinshu University from website:
• Undergraduate：　http://www.shinshu-u.ac.jp/english/faculty/
• Graduate：　http://www.shinshu-u.ac.jp/english/graduate/
• SUIC course list：　http://www.shinshu-u.ac.jp/institution/suic/upload/pdf/edu/12course_all.pdf
• Syllabi(Japanese only)：　http://campus-2.shinshu-u.ac.jp/syllabus/syllabus.dll/Top
• What you wish to learn in your first/second semester: Applicants who wish to study a major or conduct research at
Shinshu University should write details such as the title of major, the name of the faculty member by whom you wish to be
supervised or with who you have already been in contact with. But we cannot guarantee that the specified faculty member
will be assigned as your academic supervisor. Researcher Directory URL： http://www.shinshu-u.ac.jp/soar/
• Students who wish to pursue their postgraduate study at Shinshu following this program can prepare for it as a research
student and be exempt from examination, entrance and tuition fees for up to one year. Please contact us for further details.
6. Financial Information
• Students wishing to apply for a JASSO scholarship must check for eligibility beforehand in Sheet3. If you willing to
participate in this program even without JASSO scholarship, Please fill in the method of support to meet the expenses
• Method of support to meet the expenses while in Japan: A bank statement (your own or that of a close family member),
or a certificate of scholarship must be provided as an additional documents to prove the amount before acceptance.The
bank statement (their own, or that of a close family member) verifying that they possess funding as follows: For a onesemester exchange: the equivalent of 500,000 JPY. For a one-year exchange: the equivalent of 1,000,000 JPY.
7. Immigrate Related Information
• Visa application site: Please write the place(city) of Japanese Embassy or Consulate of Japan in charge of your area.
8. Signature
• Write your signature and date by hand in the boxes provided at the bottom of the page.
Sheet2.About JASSO_E
About JASSO Scholarship (Student Exchange Support Program)
The Ministry of Education, Japan (MEXT), in collaboration with the Japan Student Services Organization (JASSO), offers
scholarships under the “Student Exchange Support Program” for short-term study in Japan. The scholarship program is
intended to encourage student exchange between universities in Japan and their overseas partner institutions, promote
understanding and friendship between the countries participating, and strengthen the internationalization and
competitiveness of Japanese universities. If Shinshu University Exchange Student Program is selected as an exchange
student program by JASSO, Shinshu University will nominate candidates from the applicants of exchange student
program.
1. Eligibility
1) Applicants must be enrolled at one of our partner universities with a student exchange agreement as a degree-seeking
undergraduate or postgraduate student for their whole study period at Shinshu University. The applicant should be of a
nationality with which Japan has diplomatic relations. Taiwanese or Palestinian students are also eligible to apply.
2) Applicants must possess excellent academic and personal records at their home universities. A minimum grade point
average of 3.1 on a scale of 4.0 (or the equivalent) for the academic year prior to admission is required.
3) Applicants must, due to financial difficulty, be unable to finance their studies in Japan independently.
4) Applicants must, upon completion of the exchange term, return to their home universities to resume their studies or be
awarded with their degrees.
5) Applicants must be eligible to obtain a ‘student’ visa for the purpose of study in Japan, and therefore must hold a
nationality other than Japanese.
6) Applicants must not be recipients of scholarship awards from other organizations, if the combined value of these
additional scholarships exceeds ¥80,000 per month.
7) Applicants must, upon completion of their scholarship term, submit a study report to Shinshu University, and respond to
various surveys from JASSO or Shinshu University even after leaving Japan.
Please be advised that meeting the above requirements does not guarantee admission to the program.
2. Period of Study
In general, the period of study is the period spent as an exchange student at Shinshu University (up to 12 months).
3. Scholarship Provisions
A monthly stipend of:　¥80,000 * Amount of scholarship may change due to limitations in the government budget.
4. Application Procedure
Students wishing to apply for a JASSO scholarship must check "Yes" on question 5 of the application form (“Are you
intending to apply for a JASSO scholarship?”). Only applicants who check “Yes” will be considered for scholarship
nomination.
If Shinshu University Exchange Student Program is selected by JASSO as a student exchange support program, Shinshu
University will inform the selected students of their nomination through their home universities by the following dates, and
maybe request any necessary supporting documents.
・ Autumn semester applicants (arriving in Japan in late September): Late April
・ Spring semester applicants (arriving in Japan in early April): Late January
5. Notification of Results
Students will be officially notified by Shinshu University through their home universities of the result of their application as
follows:
・ Fall semester applicants (arriving in Japan in late September): Late August
・ Spring semester applicants (arriving in Japan in early April): Late March
ใบสมัครเข้าร่วมโครงการนิสิตแลกเปลี่ยนมหาวิทยาลัยเกษตรศาสตร์
ส่วนที่ 1 รายละเอียดโครงการแลกเปลี่ยน
มหาวิทยาลัยคู่สัญญาที่สมัครเข้าร่วมโครงการแลกเปลี่ยน .......................................................................ประเทศ.......................................
ภาคการศึกษาที่สมัคร □ เมษายน 2558 – กันยายน 2558 □ ตุลาคม 2558 – มีนาคม 2559
□ อื่นๆ................................................................
* หากท่านได้รับการคัดเลือกเป็นนิสิตแลกเปลี่ยน แต่ไม่ได้รับทุนการศึกษาจะยังยินดีเข้าร่วมโครงการหรือไม่ □ ยินดี □ ไม่ยินดี
ส่วนที่ 2 รายละเอียดผู้สมัคร
1. ชื่อ (นาย/นาง/นางสาว)...........................................................นามสกุล...........................................................................
Name (Mr./Mrs./Ms.)......................................................... Surname.........................................................................
รู ปถ่าย
วัน/เดือน/ปีเกิด....................................................................อายุ.....................................................................................
ติดที่นี่
นิสิตระดับ □ ปริญญาตรี □ ปริญญาโท □ ปริญญาเอก ชั้นปีที่.............................................................................
คณะ...................................................................................ภาควิชา..................................................................................
สาขาวิชา...........................................................................รหัสประจาตัว.........................................................................
เกรดเฉลีย่ สะสม................................................................................................................................................................
เบอร์โทรศัพท์ที่สามารถติดต่อได้.........................................................................อีเมล์..........................................................................................
2. ความรู้ทางด้านภาษา
□ ภาษาอังกฤษ
□ TOEFL ...................... □ IELTS......................... □ TOEIC.........................
□ ภาษาอื่นๆ ..........................................................................................................................................
3. เหตุผลที่สนใจจะเป็นนิสติ แลกเปลี่ยน………………….……………………………………………………..………………….…….....................................................
...................................................................................................................................................................................................................................
4. ท่านเคยได้รับทุนหรือเข้าร่วมโครงการแลกเปลีย่ นมาก่อนหรือไม่ (ถ้ามีโปรดระบุ)................................................................................................
...................................................................................................................................................................................................................................
5. ชื่อผู้ปกครอง.................................................................................อาชีพ................................................................................................................
ความเกี่ยวข้องกับนิสิต.......................................................................อีเมล์............................................................................................................
ทีอ่ ยู.่ .........................................................................................................................................โทรศัพท์................................................................
6. ชื่ออาจารย์ที่ปรึกษา........................................................................................ตาแหน่ง.........................................................................................
อีเมล์....................................................................................โทรศัพท์....................................................................................................................
7. ผู้สมัคร □ ยอมรับเงื่อนไขการสมัครต้องไม่อยู่ในระหว่างการสมัครเข้าร่วมโครงการแลกเปลี่ยนนักศึกษาโครงการอื่นใดของ
กองวิเทศสัมพันธ์และในระดับคณะจนกระทั่งใบสมัครได้รับการพิจารณาว่าเป็นที่สิ้นสุดแล้วโดยกองวิเทศสัมพันธ์และมหาวิทยาลัย
เกษตรศาสตร์
8. ผู้สมัคร □ ยืนยันว่า ได้ทาการสืบค้นข้อมูลในส่วนที่เป็นทางด้านวิชาการ การใช้ชีวิตในต่างประเทศและเงื่อนไขในการเป็นนิสติ
แลกเปลี่ยนที่กาหนดโดยมหาวิทยาลัยคูส่ ัญญาเป็นที่เรียบร้อยแล้ว อีกทั้งได้ทาการปรึกษากับคณะต้นสังกัดและผู้ปกครองแล้วเช่นกัน
ผู้สมัครรับทราบถึงข้อมูลทีไ่ ด้มาและเห็นชอบด้วยประการ
9. ผู้สมัครขอรับรองว่าข้อความดังกล่าวข้างต้นเป็นจริงทุกประการ หากผู้สมัครได้รับคัดเลือกเป็นนิสติ แลกเปลี่ยน ผูส้ มัครยินดีและพร้อมที่จะ
ปฏิบัติตามประกาศและข้อกาหนดต่างๆ ทุกประการ หากมีการตรวจสอบพบในภายหลังว่ามีข้อความที่ไม่เป็นจริงผูส้ มัครยินดีให้ตัดสิทธิ์
การสมัครและเข้าร่วมโครงการแลกเปลีย่ นนักศึกษาโดยไม่มีเงื่อนไข และยินยอมให้มหาวิทยาลัยเกษตรศาสตร์พิจารณาลงโทษตามที่
เห็นสมควร
ลายเซ็นนิสิต
ลายเซ็นอาจารย์ที่ปรึกษา
(….....…………………………….………………………….)
............../................./................
(….....…………………………….………………………….)
............../................./................
*กรุณากรอกเบอร์โทรศัพท์ และอีเมล์ ที่ติดต่อได้ หากไม่สามารถติดต่อท่านได้ จะถือว่าสละสิทธิ์
**กรุณายื่นใบสมัครเข้าร่วมโครงการนิสิตแลกเปลี่ยนฯ ฉบับนี้พร้อมกับเอกสารประกอบการสมัครอื่นๆ ดังที่มหาวิทยาลัยคู่สญ
ั ญาระบุไว้ หากเอกสารประกอบการ
งานทุนและเจรจาธุรกิจ กองวิเทศสัมพันธ์
สมัครใดๆ ไม่ครบถ้วนจะไม่ได้รบั การพิจารณา
( 派遣元大学担当者が記入してください　to be completed by the contact person of home university)
信州大学交換留学生プログラム 希望学生リスト
List of Applicants for Shinshu University Exchange Student Program
* 日本語または英語でご記入ください。
* 推薦順位をつけてください。
希望学生数
Number of Applicants
派遣元大学名
Home University
派遣元大学担当者
Contact Person at Home University
* Please fill out in Japanese or English.
* Please assign priority to your applicants.
標記プログラムによる交換留学希望学生を、関係書類を添えて以下のとおり推薦いたします。*1
We recommend that the following students (accompanied by related documents) apply to the Shinshu University Exchange Student Program .
推薦順位
Priority order
学生氏名
Student's name
*1
希望留学期間*2
Planned period of enrolment at Shinshu University *2
所属学部(学科または専攻）
Faculty (Depertment or major)
秋期のみ(授業期間：10月上旬～2月上旬) Autumn Semester Only(Class Schedule: Early Oct.~ Early Feb.)
1
秋期&春期(授業期間：10月上旬～8月上旬) Autumn & Spring Semesters(Class Schedule: Early Oct.~ Early Aug.)
春期のみ(授業期間：4月上旬～8月上旬) Spring Semester Only(Class Schedule: Early Apr.~ Early Aug.)
春期&秋期(授業期間：4月上旬～2月上旬) Spring & Autumn Semesters(Class Schedule: Early Apr.~ Early Feb.)
秋期のみ(授業期間：10月上旬～2月上旬) Autumn Semester Only(Class Schedule: Early Oct.~ Early Feb.)
2
秋期&春期(授業期間：10月上旬～8月上旬) Autumn & Spring Semesters(Class Schedule: Early Oct.~ Early Aug.)
春期のみ(授業期間：4月上旬～8月上旬) Spring Semester Only(Class Schedule: Early Apr.~ Early Aug.)
春期&秋期(授業期間：4月上旬～2月上旬) Spring & Autumn Semesters(Class Schedule: Early Apr.~ Early Feb.)
秋期のみ(授業期間：10月上旬～2月上旬) Autumn Semester Only(Class Schedule: Early Oct.~ Early Feb.)
3
秋期&春期(授業期間：10月上旬～8月上旬) Autumn & Spring Semesters(Class Schedule: Early Oct.~ Early Aug.)
春期のみ(授業期間：4月上旬～8月上旬) Spring Semester Only(Class Schedule: Early Apr.~ Early Aug.)
春期&秋期(授業期間：4月上旬～2月上旬) Spring & Autumn Semesters(Class Schedule: Early Apr.~ Early Feb.)
秋期のみ(授業期間：10月上旬～2月上旬) Autumn Semester Only(Class Schedule: Early Oct.~ Early Feb.)
4
秋期&春期(授業期間：10月上旬～8月上旬) Autumn & Spring Semesters(Class Schedule: Early Oct.~ Early Aug.)
春期のみ(授業期間：4月上旬～8月上旬) Spring Semester Only(Class Schedule: Early Apr.~ Early Aug.)
春期&秋期(授業期間：4月上旬～2月上旬) Spring & Autumn Semesters(Class Schedule: Early Apr.~ Early Feb.)
*1 推薦学生は信州大学に交換留学生として在籍を希望する期間すべてにわたって、協定校に在籍している正規学生であること。
*2 事前オリエンテーションに出席するため、秋期（春期）からの参加学生は 9 月下旬（ 4 月の第一週）に、日本に到着する必要があります。秋期（春期）授業終了後に信州大学を離れても学生身分は 3 月（ 9 月）下旬まで有効です。
*1 Students must be enrolled as a degree-seeking student at their home university for the entire exchange study period at Shinshu University.
*2Students joining this program are required to arrive in Japan for a pre-class orientation as follows: those joining the program in the autumn must arrive in Japan in late September; those joining the program in the spring must arrive in Japan in early
April. The student status of applicants intending to leave Shinshu University at the end of the spring class period will be valid until late September. The student status of applicants intending to leave Shinshu University at the end of the autumn class
period will be valid until late March.
本リストと一緒に下記書類を送付してください。 Please ensure that the following documents are enclosed with this list.
信州大学交換留学生プログラム申請書 Shinshu University Exchange Student Program Application Form
成績証明書(原本) *英語もしくは日本語 Original academic transcript issued by student's home university　*Only in English or Japanese
1/1
Sheet3.Application Form
(for Autumn 2015)
信州大学交換留学生プログラム　申請書
Shinshu University Exchange Student Application Form
1. Personal Data
姓名(英語表記)
Name in English
Family Name
Given Name
Middle Name
写真 Photo
(40mm×30mm)
カタカナ姓名
Name in Katakana
漢字姓名
写真の裏に名前（英語表
記）を書いてください。
国籍
Name in Chinese
Characters(Kanji)
Nationality
婚姻状況
未婚Single
Marital Status
生年月日
性別
既婚Married
年
Y
Date of Birth
月
M
Please write your name in
English on the back.
男 Male
Sex
日
D
女 Female
出生地
国：
市：
Place of Birth
Country:
City:
現住所
Current Address
Street and Number
City
電話番号
Telephone No.
Country/State
Zip Code
ファクス番号
Country code
Eメール 1
Email Address 1
Area code
Fax No.
Number
Country code
Area code
Eメール 2
@
Number
@
Email Address 2
2. Academic Background
自国の大学名
学部
Your University
Faculty
現在の専攻
現在の学年
Current school year/grade
Current Major
学部生undergraduate
年生
大学院生(post)graduate
year/
grade
卒業予定年月日（申請者は信州大学での交換留学プログラム終了時に、所属大学に在籍していな
ければならない）Expected Date of Graduation(Note: you must be enrolled as a degree-seeking
student at your home university for your entire study period at Shinshu University)
取得予定学位
Expected Degree
年
Y
日
D
月
M
教育を受けた期間（小学校から現在まで）
年
Total Period of Education(from elementary school to present)
Year
3. Language Proficiency(except for your mother tongue)
日本語能力
Japanese skill
・話す能力Speaking
優 Excellent
良 Good
可 Fair
不可 Poor
・聞く能力Listening
優 Excellent
良 Good
可 Fair
不可 Poor
・読む能力Reading
優 Excellent
良 Good
可 Fair
不可 Poor
・書く能力Writing
優 Excellent
良 Good
可 Fair
不可 Poor
試験 Name of Examination
級)
Grade(
JLPT
スコア Score or Level
JPT
英語能力
English Skill
取得年月 Test Date (Y/M)
(
)
(
(
)
(
)
)
・話す能力Speaking
優 Excellent
良 Good
可 Fair
不可 Poor
・聞く能力Listening
優 Excellent
良 Good
可 Fair
不可 Poor
・読む能力Reading
優 Excellent
良 Good
可 Fair
不可 Poor
・書く能力Writing
優 Excellent
良 Good
可 Fair
不可 Poor
試験 Name of Examination
TOEFL(
CBT
PBT
スコア Score or Level
iBT)
取得年月 Test Date (Y/M)
(
)
(
)
IELTS
(
)
(
)
Others:
(
)
(
)
4. Planed Period of Enrolment at Shinshu University
１セメスター（半年間）/2015年10月～2016年3月 1 semester (6 months) / From Oct. 2015 to Mar.2016
信州大学での希望学習期間
Which term(s) do you wish to attend?
２セメスター（１年間）/2015年10月～2016年9月
2 semesters (1 year) / From Oct. 2015 to Sep.2016
秋学期:10月～翌年3月（2月中旬～3月下旬は春季休業）Autumn Semester:Oct. ~ Mar.(Spring vacation:Mid Feb. ~Late Mar.)
春学期:4月～9月(8月中旬～9月下旬は夏季休業) Spring Semester:Apr. ~ Sep.(Summer vacation:Mid Aug.~Late Sep.)
3 / 10
Sheet3.Application Form
(for Autumn 2015)
姓名(英語表記)　Name in English：
5. Study Plan at Shinshu University
信州大学での希望学習スタイル
原則日本語記入 Please try to write in Japanese. If that is not possible, English is also acceptable.
１学期目 1st Semester
Area of study you wish to pursue at Shinshu ２学期目 2nd Semester
日本語関連科目Japanese language-related subjects
専門科目Major subjects
日本語関連科目Japanese language-related subjects
専門科目Major subjects
(交換留学1年の場合 If your exch. period is 1Year)
専門科目を☑チェックした場合、希望する専攻
If you checked the box of major subjects, Please indicate the major of area.
志望動機 （信州大学を選ぶ理由）Purpose of Study (Reason why you chose Shinshu University）
１学期目で学びたいこと What do you wish to learn in your first semester
２学期目で学びたいこと（交換留学1年の場合） What do you wish to learn in your second semester( If your exchange period is 1 year)
信州大学の日本人学生と交流したいこと。そして、日本人学生を自分の国・大学へ交換留学させるために信州大学でやりたいこと。
What kind of activities do you wish to interact with Japanese students? And what do you want to do at Shinshu University in order to
encourage more Japanese students to study abroad in your home country or university?
留学中に何か特別な教育上の手助けを必要としますか? Do you wish to get special educational needs support at Shinshu University?
在籍大学の卒業後、大学院への進学を考えていますか？Do you wish to pursue postgraduate studies after you graduate from your home university?
はい Yes
いいえ No
まだ分からない I haven't decided yet.
信州大学大学院への進学を希望しますか？ If yes, do you wish to pursue your postgraduate studies at Shinshu University?
はい Yes
いいえ No
選択肢として考えている。I haven't decided yet, but I consider Shinshu University as a possible alternative.
4 / 10
Sheet3.Application Form
(for Autumn 2015)
姓名(英語表記)　Name in English：
6. Financial Information
JASSO奨学金に申請したいですか？(申請者は必ずSheet2.About JASSOにて応募条件を確認してください。)
Are you intending to apply for a JASSO scholarship? (Students wishing to apply must check for eligibility in sheet2.About JASSO beforehand.)
はい Yes
いいえ No
他の奨学金を受けている、または申請する予定。Has received, or is intending to apply for other scholarships.
はい Yes
いいえ No
「はい」を選んだ方は、奨学金の名称と選考結果が判明する時期を記入してください。If yes, give name and expected decision dates.
奨学金名称：
受給内容：　約
Name of scholarship:
受給期間：
Period:
円/月
JPY/month
About
月　から
Month to
年
Year
from
月
Month
年
Year
有 Yes
返済義務の有無：Do you have to pay back the scholarship in the future?
無 No
/
申請予定の場合、選考結果が判明する時期：If you are applying for other scholarships, give the expected decision dates:
年Y/月M
奨学金無しでも、本プログラムに参加しますか？ Do you have the means to participate in this program without a scholarship?
はい Yes
いいえ No
「はい」を選んだ方は、下記滞在費の支弁方法について答えてください。If yes, indicate the method of support to meet expenses while in Japan.
滞在費の支弁方法について Method of support to meet the expenses while in Japan.
本人負担　Self （約about
円/月　JPY/month)
経費支弁者　Supporter（約about
円/月　JPY/month)
支弁者氏名：
申請人との関係：
Supporter's name:
Relationship:
住所：
Home address:
職業：
勤務先：
Occupation:
Name of Corporation or Company:
自宅電話：
勤務先電話：
Telephone(home):
Telephone(office):
年収：　約
円/年
JPY/year
Annual income: about
7. Immigrate Related Information
過去の出入国暦
Have you entered or stayed in
Japan in the past?
有 (回数
Yes (
回/直近の出入国暦
time(s)/The latest entry
年
Y
在日親族
Name:
Date of Birth:
Do you have family or coresidents residing in Japan?
Name:
Date of Birth:
査証申請予定地
上陸予定港
日
D
～　～　年
Y
月
M
成田空港Narita Airport(NRT)
日）
D）
Nationality:
Relationship:
Nationality:
Relationship:
犯罪歴（日本国外におけるものも含む）
Criminal record (in Japan or overseas)
Intended place to apply for visa
Anticipated port of entry
月
M
無No
無
No
有Yes
中部国際空港Chubukokusai Centrair Airport(NGO)
羽田空港Tokyo International Haneda Airport(HND)
その他Others:(
上記の記載内容は事実と相違ありません。また日本滞在期間中は信州大学の規則に従うことを約束します。 JASSOによる「留
学生交流支援制度（短期受入）」奨学金が受給された場合、私はその奨学金の規定を遵守することを約束します。
I hereby certify that the information I have given on this form is true and correct to the best of my knowledge, and I agree to comply with all the
regulations and rules of Shinshu University during my stay in Japan. Ｉf I am chosen as a recipient of a “Student Exchange Support Program
Scholarship for Short-term Study in Japan” JASSO scholarship, I promise to abide by the provisions set out in that scholarship.
年
月
日
Year
Month
Day
署 名：
Signature
5 / 10
)
Sheet4.Sample Form
(for Autumn 2015)
信州大学交換留学生プログラム　申請書
Shinshu University Exchange Student Application Form
SAMPLE
1. Personal Data
SHINSHU
HANAKO
Family Name
Given Name
姓名(英語表記)
Name in English
カタカナ姓名
Name in Katakana
漢字姓名
Name in Chinese
Characters(Kanji)
国籍
信州　花子
婚姻状況
生年月日
1995
年
Y
10
日
22 D
出生地
国：
Place of Birth
Country:
82
123
4567890
Country code
Area code
Number
ファクス番号
Fax No.
女 Female
市：
City:
Seoul
Seoul,
Korea,
543-210
City
Country/State
Zip Code
82
123
4567891
Country code
Area code
Number
Eメール 2
shinshuhanako @gmail.com
Please write your name in
English on the back.
KOREA
Street and Number
電話番号
Email Address 1
月
M
男 Male
Sex
Apt 123 - 456, Abcd - dong, Efgh - Gu,
Current Address
Eメール 1
性別
既婚Married
写真の裏に名前（英語表
記）を書いてください。
KOREA
Nationality
未婚Single
Date of Birth
Telephone No.
写真 Photo
(40mm×30mm)
シンシュウ　ハナコ
Marital Status
現住所
Middle Name
shinshuhanako @yahoo.com
Email Address 2
2. Academic Background
自国の大学名
Your University
現在の専攻
Current Major
学部
Abcd University
College of Humanities
Faculty
現在の学年
Current school year/grade
Japanese Studies
学部生undergraduate
大学院生(post)graduate
卒業予定年月日（申請者は信州大学での交換留学プログラム終了時に、所属大学に在籍していな
ければならない）Expected Date of Graduation(Note: you must be enrolled as a degree-seeking
student at your home university for your entire study period at Shinshu University)
取得予定学位
Bachelor of Arts
Expected Degree
2
2017
年
Y
2
教育を受けた期間（小学校から現在まで）
Total Period of Education(from elementary school to present)
月
M
25
13
年生
year/
grade
日
D
年
Year
3. Language Proficiency(except for your mother tongue)
日本語能力
Japanese skill
・話す能力Speaking
優 Excellent
良 Good
可 Fair
不可 Poor
・聞く能力Listening
優 Excellent
良 Good
可 Fair
不可 Poor
・読む能力Reading
優 Excellent
良 Good
可 Fair
不可 Poor
・書く能力Writing
優 Excellent
良 Good
可 Fair
不可 Poor
試験 Name of Examination
Grade(
JLPT
N1
スコア Score or Level
級)
JPT
英語能力
English Skill
(
105
(
取得年月 Test Date (Y/M)
)
(
)
(
2013/8
)
・話す能力Speaking
優 Excellent
良 Good
可 Fair
不可 Poor
・聞く能力Listening
優 Excellent
良 Good
可 Fair
不可 Poor
・読む能力Reading
優 Excellent
良 Good
可 Fair
不可 Poor
・書く能力Writing
優 Excellent
良 Good
可 Fair
不可 Poor
試験 Name of Examination
TOEFL(
CBT
PBT
スコア Score or Level
iBT)
)
取得年月 Test Date (Y/M)
(
)
(
)
IELTS
(
)
(
)
Others:　TOEIC
(
)
(
500
2011/10
)
4. Planed Period of Enrolment at Shinshu University
１セメスター（半年間）/2015年10月～2016年3月 1 semester (6 months) / From Oct. 2015 to Mar.2016
信州大学での希望学習期間
Which term(s) do you wish to attend?
２セメスター（１年間）/2015年10月～2016年9月
2 semesters (1 year) / From Oct. 2015 to Sep.2016
秋学期:10月～翌年3月（2月中旬～3月下旬は春季休業）Autumn Semester:Oct. ~ Mar.(Spring vacation:Mid Feb. ~Late Mar.)
春学期:4月～9月(8月中旬～9月下旬は夏季休業) Spring Semester:Apr. ~ Sep.(Summer vacation:Mid Aug.~Late Sep.)
6 / 10
Sheet4.Sample Form
(for Autumn 2015)
姓名(英語表記)　Name in English：
SHINSHU, HANAKO
5. Study Plan at Shinshu University
信州大学での希望学習スタイル
SAMPLE
原則日本語記入 Please try to write in Japanese. If that is not possible, English is also acceptable.
１学期目 1st Semester
Area of study you wish to pursue at Shinshu ２学期目 2nd Semester
日本語関連科目Japanese language-related subjects
専門科目Major subjects
日本語関連科目Japanese language-related subjects
専門科目Major subjects
(交換留学1年の場合 If your exch. period is 1Year)
専門科目を☑チェックした場合、希望する専攻
If you checked the box of major subjects, Please indicate the major of area.
The Department of Japanese Language and Literautre in the Faculty of Artｓ
志望動機 （信州大学を選ぶ理由）Purpose of Study (Reason why you chose Shinshu University）
１学期目で学びたいこと What do you wish to learn in your first semester
２学期目で学びたいこと（交換留学1年の場合） What do you wish to learn in your second semester( If your exchange period is 1 year)
信州大学の日本人学生と交流したいこと。そして、日本人学生を自分の国・大学へ交換留学させるために信州大学でやりたいこと。
What kind of activities do you wish to interact with Japanese students? And what do you want to do at Shinshu University in order to
encourage more Japanese students to study abroad in your home country or university?
留学中に何か特別な教育上の手助けを必要としますか? Do you wish to get special educational needs support at Shinshu University?
在籍大学の卒業後、大学院への進学を考えていますか？Do you wish to pursue postgraduate studies after you graduate from your home university?
はい Yes
いいえ No
まだ分からない I haven't decided yet.
信州大学大学院への進学を希望しますか？ If yes, do you wish to pursue your postgraduate studies at Shinshu University?
はい Yes
いいえ No
選択肢として考えている。I haven't decided yet, but I consider Shinshu University as a possible alternative.
7 / 10
Sheet4.Sample Form
(for Autumn 2015)
姓名(英語表記)　Name in English：
SHINSHU, HANAKO
SAMPLE
6. Financial Information
JASSO奨学金に申請したいですか？(申請者は必ずSheet2.応募条件を確認してください。)
Are you intending to apply for a JASSO scholarship? (Students wishing to apply must check for eligibility in sheet.2 beforehand.)
はい Yes
いいえ No
他の奨学金を受けている、または申請する予定。Has received, or is intending to apply for other scholarships.
はい Yes
いいえ No
「はい」を選んだ方は、奨学金の名称と選考結果が判明する時期を記入してください。If yes, give name and expected decision dates.
奨学金名称：
受給期間：
Period:
受給内容：　約
ABC Scholarship
Name of scholarship:
年
Year
2015
from
月　から
Month to
4
2016
年
Year
月
Month
3
有 Yes
返済義務の有無：Do you have to pay back the scholarship in the future?
円/月
JPY/month
40,000
About
無 No
2014/12
申請予定の場合、選考結果が判明する時期：If you are applying for other scholarships, give the expected decision dates:
年Y/月M
奨学金無しでも、本プログラムに参加しますか？ Do you have the means to participate in this program without a scholarship?
はい Yes
いいえ No
「はい」を選んだ方は、下記滞在費の支弁方法について答えてください。If yes, indicate the method of support to meet expenses while in Japan.
滞在費の支弁方法について Method of support to meet the expenses while in Japan.
本人負担　Self （約about
円/月　JPY/month)
80,000
経費支弁者　Supporter（約about
支弁者氏名：
円/月　JPY/month)
申請人との関係：
SHINSHU TARO
Supporter's name:
住所：
Father
Relationship:
Apt123-456, Abcd-dong, Efgh-gu, Seoul, Korea, 543-210
Home address:
職業：
勤務先：
Office Worker
Occupation:
自宅電話：
Name of Corporation or Company:
勤務先電話：
+82-123-45-6789
Telephone(home):
年収：　約
+82-234-54-3210
Telephone(office):
円/年
JPY/year
5,000,000
Annual income: about
Sakura corporation
7. Immigrate Related Information
過去の出入国暦
Have you entered or stayed in
Japan in the past?
在日親族
Do you have family or coresidents residing in Japan?
有 (回数
Yes (
2
回/直近の出入国暦
time(s)/The latest entry
～　～　2010年
Y
1月
M
6日）
D）
無
No
Date of Birth:1960/5/20
Nationality:Japanese
Relationship: Aunt
Name:
Date of Birth:
Nationality:
Relationship:
査証申請予定地
上陸予定港
28日
D
Name:SHINSHU HARU
犯罪歴（日本国外におけるものも含む）
Criminal record (in Japan or overseas)
Seoul
Intended place to apply for visa
Anticipated port of entry
2009年 12月
Y
M
成田空港Narita Airport(NRT)
無No
有Yes
中部国際空港Chubukokusai Centrair Airport(NGO)
羽田空港Tokyo International Haneda Airport(HND)
その他Others:(
上記の記載内容は事実と相違ありません。また日本滞在期間中は信州大学の規則に従うことを約束します。 JASSOによる「留
学生交流支援制度（短期受入）」奨学金が受給された場合、私はその奨学金の規定を遵守することを約束します。
I hereby certify that the information I have given on this form is true and correct to the best of my knowledge, and I agree to comply with all the
regulations and rules of Shinshu University during my stay in Japan. Ｉf I am chosen as a recipient of a “Student Exchange Support Program
Scholarship for Short-term Study in Japan” JASSO scholarship, I promise to abide by the provisions set out in that scholarship.
2015
年
Year
2
月
Month
20
日
署 名：
Day
Signature
8 / 10
Shinshu Hanako
)
Ref.Instruction_J
信州大学交換留学生プログラム申請パッケージ
Application package for Shinshu University Exchange Student Application Form
概　要
1. 本申請パッケージには下記の内容が含まれています。
• シート1.　記入時の注意事項（日本語版）
• シート2.　JASSO奨学金について（日本語版）
• シート3.　信州大学交換留学生プログラム申請書
• シート4.　信州大学交換留学生プログラム申請書の記入例
2. すべての項目を日本語又は英語により明瞭に記入してください。(パソコン入力でも手書きでも良いですが、署名欄は必ず手書
きでサインしてください。) 未記入がある場合は受付けられません。
3. 信州大学交換留学生プログラム申請書及び成績証明書以外に、後日追加書類を提出することもあります。追加書類リストにつ
いては申請結果と一緒に在籍大学に通知します。
記入時の注意事項
1. Personal Data
• パスポートと同じ姓名（英語表記）を書いてください。（例えパスポートに間違ってつづったとしても）
• カタカナ姓名： 自分の名前を日本語のカタカナで書いてください。分からない場合は自国の日本語教師等に聞いてください。
• 漢字姓名： 漢字姓名のある学生は漢字で書いてください。
2. Academic Background
• 卒業予定年月日： 在籍大学の学期、信州大学での交換留学期間を考慮して、記入してください。
3. Language Proficiency
• 日本語能力試験に合格した場合、級とスコアを書いてください。
• 英語は母国語でない場合、英語能力を自己評価してください。英語試験(e.g.,TOEFL, IELTS, TOEIC)を受けた人は、試験名とスコア
を書いてください。
• 信州大学の授業は語学科目を除き、全て日本語で行われています。英語による授業を実施していませんのでご注意ください。来
日後、プレースメントテストの結果よりクラスが決まります。日本語レベルや教室収容能力により履修できない科目があります。下記
URLから最新の募集要項をご参考ください。http://www.shinshu-u.ac.jp/institution/suic/prospective/exchange-in/
4. Planed Period of Enrolment at Shinshu University
• 事前オリエンテーションに出席するため、秋学期（春学期）からの参加学生は9月下旬（4月の第一週）に、日本に到着する必要が
あります。秋学期（春学期）授業終了後に信州大学を離れても学生身分は3月（9月）下旬まで有効です。
5. Study Plan at Shinshu University
• 信州大学での希望学習スタイル：何らかの日本語科目を受講する場合は日本語関連科目も選んでください。
• 教育学部・工学部・農学部・繊維学部は日本語関連科目が実施される松本キャンパスから遠く離れており、日本語関連科目と上
記4学部の専門科目を同時に受講することはできません。
• 下記URLより信州大学で希望する学部・専攻を選んでください。
• 学部案内 ：　http://www.shinshu-u.ac.jp/faculty/
• 大学院案内：　http://www.shinshu-u.ac.jp/graduate/
• センター日本語授業 ：　http://www.shinshu-u.ac.jp/institution/suic/upload/pdf/edu/12course_all.pdf
• シラバス検索(日本語のみ)：　http://campus-2.shinshu-u.ac.jp/syllabus/syllabus.dll/Top
• １または２学期目で学びたいこと： 専門科目を学習（または研究）したい人は受けたい授業、指導を受けたい（またコンタクトした）
教員を詳細に書いてください。但し、必ずしもご希望の教員に指導される保証はありません。
参考：信州大学研究者総覧 http://www.shinshu-u.ac.jp/soar/
• 交換留学終了後、信州大学大学院への入学を目指すために研究生として入学することを希望する方については、大学院入学前１
年以内の授業料・検定料・入学料を不徴収とします。詳細についてはお問い合わせください。
6. Financial Information
• JASSO奨学金への申請希望者は必ずSheet4で応募条件を確認してください。JASSO奨学金がなくても本プログラムに参加したい
学生は、滞在費の支弁方法項目も記入してください。
• 滞在費の支弁方法について：受入前に本人または家族名義の銀行残高証明書、または奨学金受給証明書を提出していただき、
下記に相当する資金を確保していることを証明する必要があります。留学期間が1学期の場合：50万円相当。留学期間が2学期の場
合：100万円相当。
7. Immigrate Related Information
• 査証申請予定地：申請学生の所在地を管轄している日本国大使館/領事館の場所（都市）を記入してください。
8. Signature
• 最後に申請年月日を書いて、手書きでサインしてください。
Ref.About JASSO_J
日本学生支援機構（JASSO) 奨学金について
日本政府文部科学省は日本学生支援機構（Japan Student Services Organization (JASSO))との協力により「海外留学支援制度
（短期受入れ）」に基づいて短期留学生に対する奨学金を支給しています。この奨学金制度は、日本の大学と海外の協定大学との間
の留学生交流を推進し、日本と各国間の相互理解と友好親善を増進するとともに、日本の大学の国際化・国際競争力強化に資するこ
とを目的としています。信州大学交換留学生プログラムが採択された場合は、応募者から推薦候補者を選出します。
1. 資格及び条件　1. 応募学生は、信州大学と学生交流協定を締結している大学の学部または大学院の正規課程に在籍していて、かつ、日本と国交
のある国の国籍を有する者。なお、台湾、パレスチナの学生も対象とする。
2. 在籍大学における学業成績が優秀で、人物等に優れていること。受入前年度の成績が、ＧＰＡ ４．０スケールの３．１以上である。
3. 経済的理由により、自費のみでの留学が困難であること。
4. 日本での留学期間終了後、速やかに在籍大学に戻り学業を継続する者、又は在籍大学の学位を取得する者。
5. 日本への留学にあたり、「留学」の在留資格を確実に取得しえる者。
6. 他団体等から留学のための奨学金を受ける場合、他団体からの奨学金の支給月額の合計が８万円を超えない者。
7. 応募学生は奨学金受給期間の終了後、すみやかに学業報告書を信州大学へ提出すること。日本学生支援機構または信州大学
からの各種調査に協力すること。帰国後も調査に協力できること。
上記の条件をすべて満たしていても、採用される保証がありませんので、あらかじめ十分な資金を準備しておく必要があります。
2. 奨学期間
原則として、信州大学での交換留学期間（最長12ヵ月）。
3. 奨学金の詳細
月額奨学金　：　¥80,000 *奨学金の内容は日本政府の予算状況により変更する可能性があります。
4. 応募方法
「留学生交流支援制度」奨学金への応募を希望する学生は、交換留学生プログラム申請書のJASSO奨学金応募項目（質問5）で
「Yes」を選択してください。
信州大学交換留学プログラムは「留学生交流支援制度」に採択された場合、「Yes」を選んだ方の中から信州大学の学内選考で候
補者を選出し、下記の日程で選考結果を候補者の在籍大学に通知する予定です。その際、応募に必要な書類の提出をお願いする
場合もあります。
秋期入学（9月下旬日本到着）：　4月下旬
春期入学（4月上旬日本到着）：　1月下旬
5. 採否結果の通知
採否結果は、下記の日程で信州大学を通じて応募学生の在籍大学に通知される予定です。
秋期入学（9月下旬日本到着）：　8月下旬
春期入学（4月上旬日本到着）：　3月下旬