| Personal Information: |
| Family Name
|
(as it appears on your passport) |
| First Name
|
(as it appears on your passport) |
| Middle Name
|
(as it appears on your passport) |
Family Name
(in Japanese katakana) |
|
First Name
(in Japanese katakana) |
|
Middle Name
(in Japanese katakana) |
|
Family Name
(in Chinese characters/kanji) |
|
First Name
(in Chinese characters/kanji) |
|
Middle Name
(in Chinese characters/kanji) |
|
| Nationality |
|
| Gender |
Male
Female |
| Date of
birth |
e.g. 1998/01/25
(yyyy/mm/dd) |
| Country of
your home institution |
|
| Home institution |
|
|
Faculty/Department/Graduate School* |
|
| Major |
|
| Expected date of
graduation from your home university |
e.g. 2023/05/15
(yyyy/mm/dd) |
| Study Abroad Term at
Keio |
|
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Do you need to obtain a visa to enter Japan? |
Yes
No |
|
|
None
Beginner
Intermediate
Advanced
Native |
|
Are you planning to take
an elementary Japanese language course (CEMS accredited courses) at Keio? |
Yes
No |
|
Do you have any food
restrictions such as allergy or by religious reasons? |
Yes
No
If Yes, please list the foods you have restrictions on.
|
Education (Academic history going back until high school) :
Name of Institution, School/Department, Major, Location, Period
(yyyy/mm-yyyy/mm), Degree Earned
[e.g. Keio University, Faculty of Economics, Tokyo
JAPAN, 2000/04-2004/03, B.A.] |
|
|
Employment :
Name of Organization, Location, Type of Work, Period
(yyyy/mm-yyyy/mm)
[e.g. XXX Company, Tokyo, JAPAN, Summer Intern,
2000/07-2000/08] |
|
|
| Contact information
(Present Address):
|
| Mailing Address
* |
Apartment/Street |
|
|
Town/City |
|
|
State/Province |
|
|
Postal Code |
|
|
Country |
|
| Telephone number |
[e.g. (+81) 3-5427-1617]
Please be sure to include the country code, (+XX).
|
| E-mail address |
Note: Please be sure to register the e-mail address that you use/check regularly. |
| Confirm e-mail address |
|
| Contact information
(Permanent Address):
|
|
Same
as above. |
| Mailing Address
* |
Apartment/Street |
|
|
Town/City |
|
|
State/Province |
|
|
Postal Code |
|
|
Country |
|
| Telephone number |
[e.g. (+81) 3-5427-1617]
Please be sure to include the country code, (+XX). |
| Emergency Contact information |
| Full Name |
|
| Relationship |
|
| Mailing Address
* |
Apartment/Street |
|
|
Town/City |
|
|
State/Province |
|
|
Postal Code |
|
|
Country |
|
| Telephone number |
[e.g. (+81) 3-5427-1617]
Please be sure to include the country code, (+XX). |
| E-mail address |
|
I certify that the information given in this application is complete and accurate to the best of my knowledge, and I hereby agree to the following statements:
- If admitted, I agree to comply with the rules and regulations of Keio University.
- I consent to Keio University sharing my personal information (full name, name
of home institution, gender, age, nationality, e-mail address, and dietary
restrictions) within the CEMS Community*. Your information will be used for
administrative purposes only and will not be shared with third parties without
prior consent. (*CEMS Community includes but not limited to the CEMS Global
Office, CEMS Student Board, CEMS Club, professors and instructors, your cohort and partner
companies (for the purpose of company visits).)
- I understand that screenshots and videos will be taken throughout the program, and they may be used by Keio University for its PR activities on various media, including the university website, Social Network Services, and/or in promotional literature.
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Application Documents: Please upload the required documents by clicking the
"Choose File" button. |
|
Study Proposal * |
(PDF format) |
|
Official Transcript from your home university
* |
(PDF format)
*If issued in a language other than English or Japanese, please also upload an English translation. |
|
An
English translation of the transcript (If applicable) |
(PDF format) |
|
Certificate of Health * |
(PDF format) |
|
Application for Certificate of Eligibility (COE)
* |
(Excel format)
|
|
Certificate of Financial Support * |
(PDF format) |
|
A letter of support (If applicable) |
(PDF format) |
| A copy of
Passport (the page including your photo) * |
(PDF format) |
| Your photo * |
(JPEG(JPG) or PNG format)
*taken within the last 3 months and 3cm x 4cm. Please refer to
Photo Specifications. |
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*Personal information is handled securely and appropriately in compliance with the Keio University Basic Policy Concerning Protection of Personal Information and the Keio University Rules to Protect Personal Information. Personal information provided shall be used only for verifying the qualifications of applicants, handling administrative procedures, and making necessary arrangements for applicants. Keio University may disclose applicants’ personal information to third parties, but only within the scope deemed appropriate and necessary. Personal information will not be used for any other purposes.
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