立命館大学 AO選抜入学試験入学志願票（2016年度）【国際関係学部　グローバル・スタディーズ専攻選抜方式】 No．５太枠内を記入すること。※欄は記入しないこと。姓（Family Name）１．氏名 ※受験番号名（Given Name）フリガナ写真貼付欄 English Alphabet 3ｃｍ×2.5ｃｍ裏面に氏名・志望学部を記入すること漢字 ※ ※大学使用欄２．生年月日 □男1 19 年日３．性別 □女2 月都道府県（国外の場合は国名）４．受験票・結果通知等送付先住所電話番号市郡区〒町村番地マンション名・部屋番号携帯自宅＠５．E-mail ６．出身高等学校等所在地学校名国名（国外の場合）設置都道府県 □　国公立　□　私立　□　その他高校コード課程コード課程卒業/修了（見込）年月フリガナ７．保護者氏名・連絡先＊右の住所は、４．受験票・結果通知等送付先と異なる場合のみ記入氏名姓名続柄都道府県（国外の場合は国名）住所電話番号年制　科月 □　父51　□　母52 □　その他（　）市郡区〒町村番地マンション名・部屋番号携帯自宅８．志望学部・学科・専攻学部国際関係学部学科専攻志望コード国際関係学科グローバル・スタディーズ専攻１５０２９．英語能力試験試験の種類等 □　実用英語技能検定(英検）スコア・級提出方法等（　）級合格証明書を出願書類に同封 ® （　）点 Official Score Report をETSより直送⇒申請日（　）月（　）日 ® □　TOEIC （　□　IELTS　（ Academic Module ）（　） □　GTEC CBT （　□　TOEFL （ □　iBT　□　PBT ） □　直近6年間の学校教育を英語で受けた）点 Official Score Certificate を出願書類に同封 Test Report Form を出願書類に同封または実施機関より直送）点スコアレポートを出願書類に同封＊該当教育機関の証明書の提出を求める場合があります。 ※大学使用欄 10．入学検定料納入の証明 □　コンビニエンスストア決済の場合：「収納証明書」を右の欄に貼付 □　クレジットカード決済の場合：「収納証明書」を右の欄に貼付 □　日本国外の金融機関から日本円送金の場合：領収書（送金依頼書）のコピーを出願書類に同封収納証明書貼付欄 Registration Form（調査票書式B1） NAME:（English Alphabet）氏名:（漢字） 1. Official Education Please list, in chronological order, all schools attended from elementary school to your current or most recent school, including university. DO NOT include nursery, kindergarten or language schools. 12 years of official education are required (or must be scheduled to be completed by the time of enrollment). Please write the school name in English. Period of Attendance School Category Medium of Instruction School Address (City, Country) ABCD Elementary School Elementary Japanese Tokyo, Japan 2004 4 2009 8 5 EFGH International School Elementary English Hawaii, USA 2009 9 2010 6 1 Middle English Hawaii, USA 2010 9 2013 6 3 Name of School EFGH International Middle School IJKL Foreign Language High School Senior High Korean Seoul, ROK Start Date Year 2013 Years Attended End Date Month Year 6 Month 2 2016 3 prospective Total Years of Education: ( ) years 2. Other Attended Schools Please list any other schools that you have attended (e.g. language schools, specialized institutions). Name of School School Category Medium of Instruction School Address (City, Country) Period of Attendance Start Date Year Years Attended End Date Month Year Month 3. Employment History If you are currently working or have been employed previously, please enter your work details and job descriptions below. If you are presently employed, please submit a letter of employment. Do not include part-time work. Name and Address of Company Period of Work Title From Year Month To Year Month 2016立命館大学 Application Essays NAME:（English Alphabet）（志望理由書および小論文書式Ｂ２）氏名:（漢字） IMPORTANT Each essay has a word limit (Essay 1&2: 300 words, Essay 3: 600 words). Essays that are too short or too long will not be considered. Applicants must include the word count at the end of the each essay. The Essays must be signed and dated by the applicant by hand. Essays without a date, signature or word count will not be considered. The Essays may be typed or written by hand. If handwritten, please ensure legibility. You may use additional sheets of paper if necessary. GS Essay 1: Reason(s) why you want to study in Global Studies Major at Ritsumeikan University (300 words) Word Count: /300 Date: Signature: 2016立命館大学 NAME:（English Alphabet）氏名:（漢字） GS Essay 2: Write about a past experience that you are proud of and how you intend to apply this experience in Global Studies Major at Ritsumeikan University (300 words) Word Count: /300 Date: Signature: 2016立命館大学 NAME:（English Alphabet） GS Essay 3: 氏名:（漢字） IMPORTANT This essay has a 600-word limit excluding title and reference list. Essays that are too short or too long will not be considered. Make sure to have an appropriate title and reference list. Make sure to have correct citations in the main body of your essay whenever you refer to specific data, facts or opinions, and to have reference list at the end. Select an issue which international society is currently facing, describe its background and trials/efforts to solve it, and state your own opinion about future perspective on the issue (600 words) Date: Signature: Page 1 2016立命館大学 NAME:（English Alphabet） Word Count: /600 Date: 氏名:（漢字） Signature: Page 2 2016立命館大学 Letter of Reference（推薦書書式B3） MUST NOT BE FILLED IN BY THE APPLICANT The student below is applying to Ritsumeikan University for admission to an undergraduate program of study in Japan. To assist us in the selection process, we would be most grateful if you could complete this form. 1. Please honestly evaluate the applicant’s qualities and potential to carry out studies at the undergraduate level. 2. Please date and sign this form. 3. The contents of this form are confidential and should not be shared with the applicant. 4. This form must be sealed in an envelope and returned to the applicant. 5. Please also enclose your business card in the envelope, if available. I. Your Details Name Occupation School/Organization Name School/Organization Address Postal Code: Phone Number Country: E-Mail II. Applicant Evaluation 1. Please write the name of the applicant. _________________________________________ 2. How long have you known the applicant? _________________________________________ 3. In what capacity do you know the applicant? (e.g. teacher from the high school)___________________________ 4. Please assess the applicant on a scale of 1 (lowest) to 5 (highest) in relation to the following criteria by circling the appropriate number: Low 5. --------------------- High Intellectual ability Motivation Problem solving ability Leadership 1 1 1 1 2 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 Unable to Comment Written communication skills in English Oral communication skills in English Overall assessment of applicant 1 1 1 2 2 2 3 3 3 4 4 4 5 5 5 Unable to Comment Unable to Comment Unable to Comment Unable to Comment Unable to Comment Unable to Comment Please make further comments on the ability and potential of the applicant, or any remarks that may be of assistance in assessing this application. (If the space provided below is insufficient, please feel free to attach a separate recommendation letter.) Date:_______________________ Signature:________________________________________ Before returning this form to the applicant, please put the complete form in an envelope, seal it, and sign your name across the seal. 2016立命館大学速　達５３９８６９１日本郵便　新大阪郵便局留立命館大学　AO入試願書受付センター　行簡易書留速達引　受　番　号提出すべき書類がそろっているか確認し、封入した書類の□に ☑を入れてください。注意　郵便局窓口で簡易書留速達の手続きを行ってください。ポストへの投函不可！＜全員提出する書類＞ □ 入学志願票（顔写真・入学検定料収納証明書が貼付済であること） □ 高等学校調査書（厳封されたもの）等＜該当者のみ提出する書類＞ □ エントリーシート（書式A1） □ 共通課題論文・課題レポート・志望理由書等（書式A2） □ 活動実績報告書（書式A3） □ 証明資料貼付用紙（書式A5） □ 出願者申告書（書式A6） □ 履歴書（書式A7） □ 自作ソフトウェア確認書（書式A8） □ ソフトウェア概要書（書式A9） □ 数学Ⅲ学習計画書（書式A10） □ 科学技術コンテスト団体受賞者確認書（書式A11） □ 自作したソフトウェア（CD-R、DVD-R、USBメモリ等） □ 調査票〔英語〕（書式B1） □ 志望理由書および小論文〔英語〕（書式B2） □ 推薦書〔英語〕（書式B3） □ 語学検定試験の成績証明書（□TOEFL®、IELTSのため直送） □ 学校案内等の資料 □ 実用数学技能検定（数検）準1級以上合格証明書 □ 短期大学・大学等の卒業証明書 □ その他（）学部学科志望学部等学域専攻方式入試方式・型志願者氏名〒－志願者住所ＡＯ選抜入学試験出願書類在中　