Frequently Asked Questions

Frequently Asked Questions
About the University-Recommended Monbukagakusho Scholarship Application
Dear Applicant,
Please refer to this F.A.Q. first if you have any questions about the required application
documents or how to fill them in. We also recommend that before organizing each of the documents
for your application, you read through each document’s corresponding section in this F.A.Q. for
information. By following the advice in this F.A.Q., you will be able to write a more complete
application with fewer errors. This FAQ concerns the University-recommended Monbukagakusho
Scholarship. For more information, please navigate the Ritsumeikan University Financial Aid
homepage or the Monbukagakusho’s scholarship homepage.
*Please remember to read each question carefully when filling out your application documents*
The Ritsumeikan and Monbukagakusho Application Forms
Q. The Application Guidelines and
Monbukagakusho application form require a
photo that is 3.5 cm by 4.5 cm, but the
Ritsumeikan University form asks for one that
is 4 cm by 5 cm. Can I use the same photo for
both?
A. You may use a 3.5 cm wide by 4.5 cm high photo
for all of the forms, so long as it meets all the other
requirements.
Q. My country uses a different system of
counting years. Can I enter dates in my
country's system?
A. No, all dates on all forms must be written in the
Western system (also called AD or CE). All dates
must include a year and month at least, and day
wherever possible.
Q. I do not have a residence status in Japan.
What should I fill in for my residence status
and arrival date?
A. Please leave those questions blank if you do not
have a valid residence status at this time. If you do
have a valid residence status, you must fill in the
appropriate information.
Q. Where can I find the list of graduate
schools, majors, and courses?
A. Please refer to the application guidelines posted
on our homepage.
Q. I have not done any research in the field I
am applying for, do I have to fill in the
questions for research specialized in the
past?
A. Yes.
Q. I do not have an emergency contact person
in Japan, what should I fill in for that section?
A. If you do not have an emergency contact in
Japan, please leave the section blank.
Ritsumeikan University
Frequently Asked Questions
Q. What should I fill in for "current status" on
the Monbukagakusho application form?
A. If you are enrolled in a university at the time of
application, write the university name and your
student status (e.g., “ABC University, Student”). If
you are working, write your company name and your
position. If you are neither enrolled in a university or
working (i.e., recent graduate), write "unemployed."
Application Questionnaire
Q. Do I need to contact my Desired Supervising
Professor before submitting my application?
A. No. Additionally, filling in the name of a desired
supervising professor does not obligate that
professor to become your advisor in the event that
you are admitted to Ritsumeikan, nor does it give
that professor the ability to determine your
acceptance. You may be assigned to a different
advising professor based on the decision of the
graduate school.
Recommendation Letter
Q. I cannot find the Recommendation Form
for my Dean to fill in. Where can I find one?
A. This should be a Recommendation Letter clearly
addressed to “The President of Ritsumeikan
University, Japan”. There is no particular form.
Q. I know my Assistant Dean better than my
Dean. Can he/ she write my recommendation?
No. If you are in school or a recent graduate, the
Dean of your department must write your letter of
recommendation.
Q. I graduated a while ago. Can someone
from my workplace write my
recommendation?
If you graduated and have been working
somewhere for at least three years, a superior at
work can write your recommendation. The person
must be equivalent to, or higher than, the rank of
Dean at a university (e.g. company president, vice
president, branch president, etc…).
Q. Will it help my application if I send multiple
letters of recommendation?
A. No, the Monbukagakusho requires only one
recommendation, which must be from the Dean or a
higher ranking person at the most recent academic
institution at which you acquired (or are in the
process of acquiring) a degree. Additional
recommendation letters will not affect your
application.
Ritsumeikan University
Frequently Asked Questions
Certificate of Grades and Certificate of (scheduled) Graduation
Q. My Certificate is in a language other than
Japanese or English. Can I send you a certified
translation?
A. You must submit both the original and the
certified copy. Please note that all translator's
certifications should be in Japanese or English.
Q. My certificate of graduation/ grades is not in
English or Japanese and my school cannot
issue one in English or Japanese. Can I
translate it myself?
A. No. You must submit the original certificate in
addition to a certified translation made by a
qualified translator.
Q. What is the minimum GPA to apply?
A. Because grading systems vary from country to
country we do not have set minimum scores.
However, when you submit your grades or other
record of academic performance, it must include a
description of the rating system so that we can
evaluate your score against your own system to
determine the level of your academic
achievement.
Q. What do you mean by "clear explanation of
grading/ marking system"?
A. You must include an original document issued
by your university that explains your grading
system. At a minimum, this document should
equate your grading system to a 4 or 5 step
grading system such as: (Outstanding,) Excellent,
Good, Satisfactory, and Fail.
Q. I am currently enrolled in school and have
only one year of grades on my transcript. What
should I do?
A. Please submit your grades from the previous
two complete years of degree-pursuing studies,
even if they are from different institutions.
Q. What should I do if my Certificate of Grades
is not divided by year and semester?
A. Please attach supplementary documentation,
such as a course registration record, that shows
which courses composed your most recent two
years of study.
Concise Summary of Graduation Thesis for Most Recent Degree
Q. I didn’t have to write a thesis for my most
recent degree. Should I still submit something?
A. Yes. If you didn’t write a thesis, please submit a
one page summary of the research you completed
during the study towards your most recent degree.
Ritsumeikan University
Frequently Asked Questions
Passport/ ID
Q. I do not have a passport. What should I
submit?
A. Please submit a document that clearly shows
your legally registered name in your home country,
as it will appear on your passport once you have
acquired it.
Language Proficiency
Q. English is an official language in my home
country/ my previous degree was taught in
English, do I still need to provide English test
scores (i.e. TOEFL)?
A. If you don’t have an internationally recognized
English test score, a certificate issued by your
university stating your English proficiency level can
be submitted instead.
Q. What is the minimum Japanese proficiency
to apply?
A. Students applying for English based programs
do not need to demonstrate Japanese language
proficiency. Students applying to Japanese-based
programs must have sufficient Japanese ability to
undertake all of their coursework, and write their
thesis or dissertation in Japanese.
Application Procedures
Q. Is there an application fee for applicants
under the Monbukagakusho Scholarship
Program?
A. No.
Q. Is it possible to start my studies in the
spring semester (April)?
A. Results of the scholarship application process
are not finalized until June or July, so it is not
possible to begin in April. All students in
degree-seeking programs will arrive in September
to begin their studies.
Technical Difficulties
Q. I cannot read/fill in some of the fields in the
application documents. What should I do?
A. Please be sure to download the pdf file to your
computer (do not view it in your browser window),
install the latest version of Adobe Acrobat Reader
(free) and install the Japanese language pack
(free). Acrobat Reader should prompt you to install
the language pack if you do not already have it.
Ritsumeikan University
2015 MONBUKAGAKUSHO Scholarship
(Host University Recommendation)
Application Procedures (September 2015 Admission)
1. Documents to be submitted
Please refer to the checklist on the next page and ensure ALL required documents are submitted. Some of the
required documents are included in this PDF.
* Please fill in all forms electronically in this PDF, where possible, and print on A4-sized paper.
* Please print all forms SINGLE-sided.
* Please DO NOT staple your application documents.
* Documents 1, 2, 3, 4, 5, 6, 7, and 11 listed on the next page must be original versions.
* If you cannot submit your original document, you may submit a copy that is certified by the issuing
organization as being a "certified true copy" and identical to the original in all respects. Please note that certified
copy must contain the original signature or seal of the university. Photocopied seals will not be accepted.
* All signatures and seals must be original.
2. Important points for application
A) All submitted documents should be printed in the language you intend to study, either Japanese or English, on
A4-sized paper using PDF or word-processing software. If your documents such as certificates are in any
language other than Japanese or English, then you must submit the original certificate in addition to a translation
into Japanese or English. Translations will only be accepted if issued and signed by a translation company or a
qualified translator.
B) The name and birthday on all documents must be the same as that on your passport.
C) All application documents must be submitted together and delivered by a traceable international express mail
service to the address below and arrive before the application period ends.
D) Documents such as thesis summaries should be concise summaries of your thesis contents.
E) If it is determined that your application documents contain any deliberate falsifications of forgeries, your
application will not pass the examination.
F) Submitted documents cannot be returned for any reason.
3.
Application Period
Friday, March 20, 2015 – Monday, April 6, 2015
- All documents must be sent by express post (EMS, FedEx, DHL, etc)
- We will not send you a notification when we receive your application documents, so please use a
tracking service if you would like to know when your application documents have arrived.
- All documents must arrive by the deadline.
- Only posted applications will be accepted. No applications by email, fax, or walk-in will be accepted.
4.
Application Mailing Address
Ritsumeikan University International Center at BKC
1-1-1 Noji-Higashi, Kusatsu, Shiga, Japan 525-8577
Phone: +81 (0)77-561-3946
Application period: March 20, 2015 – Monday, April 6, 2015
All documents must arrive by express mail before the deadline.
Please allow sufficient time for delivery.
2015 MONBUKAGAKUSHO Scholarship
(Host University Recommendation)
Application Documents Checklist (September 2015 Admission)
Forms 1, 2, 3, 4, and 11 are included in this PDF.
1. Ritsumeikan University Application Form (Form A)
*3 pages: MUST be printed single-sided
2. APPLICATION FOR JAPANESE GOVERNMENT (MONBUKAGAKUSHO: MEXT)
SCHOLARSHIP (4 pages) *MUST be printed single-sided.
This form must be completed in the language in which your program is taught (English or Japanese).
3. Application Questionnaire (2 pages) *MUST be printed single-sided.
4. Field of Study and Study Program (2 pages) *MUST be printed single-sided.
This form must be completed in the language in which your program is taught (English or Japanese).
The "Field of Study" should outline your intended field, while "Study Program" should detail your individual
research plans and progression during your degree.
5. Recommendation Letter by the dean, or a person of higher position, at the applicant’s current
university (if the applicant has graduated, from the most recently attended school)
Letter must be addressed to the "President of Ritsumeikan University, Japan")
Please be sure the appropriate titles of the sender and addressee are included.
6. Original certification of grades achieved
Certificate of grades must show number of credits for each course.
Certificate of grades must show the year/ semester during which each credit was acquired.
Certificate must include or be accompanied by a certificate that shows a clear explanation of all possible
levels used in grading, including the pass/ fail mark.
Certificate must include grades for at least the final two years of courses of the most recently attended
undergraduate or graduate program.
7. Original certificate of graduation (or expected graduation) from most recent degree program
8. Concise summary of graduation thesis for current/most recent degree
If you didn’t write a thesis for your most recent degree (if currently enrolled, a thesis towards your current
degree), please submit a summary of your research field instead.
9. Copy of applicant’s passport, if applicable, or other government-issued family registry or
citizenship registry copy that shows applicant's legal name and birthdate
10. Copies of certificates of language proficiency For English Language:
Submit a score report from one of the following: TOEIC®, TOEFL®-iBT, TOEFL®-PBT, TOEFL®-CBT, or
IELTSTM. Copies are acceptable for these score reports.
*Test must have been taken between April 6th, 2013 and April 6th, 2015.
Applicants who cannot submit a score certificate from one of the tests above must submit an original, formal
certificate of English language ability level, or a formal letter stating as much, issued by either their current
university, or, if they have graduated, from their alma mater. Only original documents may be accepted.
*Language ability certifications must have been issued between April 6th, 2013 and April 6th, 2015.
*Applicants who intend to submit this kind of certificate must contact the International Center at BKC in advance.
11. Certificate of Health (Please use the attached form, or one with identical contents)
12. Three (3) photographs of applicant (taken within 6 months, 4.5 cm tall x 3.5 cm wide, full-faced,
chest-up, with no hats or caps).
Write applicant’s name and nationality on reverse of each photo and attach one each to the Ritsumeikan University
Application Form and the Monbukagakusho: MEXT application form in the designated locations.
Economics
Economics
)
y
n
a
f
i
(
t
n
a
c
i
l
p
p
a
f
o
e
c
n
e
i
r
e
p
x
e
k
r
o
W
✔
✔
✔
✔
A P P L I C AT I O N F O R J A PA N E S E G O V E R N M E N T ( M O N B U K A G A K U S H O : M ＥＸＴ ) S C H O L A R S H I P
日本政府（文部科学省）奨学金留学生申請書
Research Students for 2015（研究留学生）
ＩＮＳＴＲＵＣＴＩＯＮＳ（記入上の注意）
１．The application should be typed if possible, or neatly handwritten in block letters. （明瞭に記入すること｡)
２．Numbers should be in Arabic numerals.（数字は算用数字を用いること｡)
３．Years should be written using the Anno Domini system. （年号はすべて西暦とすること｡)
４．Proper nouns should be written in full and not abbreviated. （固有名詞はすべて正式な名称とし，一切省略しないこと｡)
* Personal data entered in this application will only be used for scholarship selection purposes, and contact information such as e-mail addresses
will only be used for forming related human networks after the student returns home and for sending of information by the Japanese Government.)
(本申請書に記載された個人情報については，本奨学金の選考のために使用するほかは，特に E-mail アドレス等の連絡先については，
帰国後における関係者のネットワークを作ること及び必要に応じ日本政府より各種情報を送信する以外には使用しない。）
(Sex)
１．Name in full in native language
（姓名（自国語))
(Family name)
In Roman block capitals
（ローマ字）
(Family name)
□Male（男）
，
(First name)
(Middle name)
(First name)
(Middle name)
□Female（女）
(Marital Status)
，
□Single（未婚）
（Write your name exactly same as is printed in your passport）
２．Nationality
※ Possesion of Japanese nationality
（国籍）
□Married(既婚)
□Yes, I have.（はい）
□No, I don’t have it.(いいえ)
Paste a passport sized photograph
３．Date of birth(生年月日）
or digital image taken within the
19
Year（年）
past 6 months. Write your name
Month（月）
Day（日）
Age(as of April 1,2015)年齢(2015 年４月１日現在）
and nationality in block letters on
the back of the photo.
（4.5cm×3.5cm photo）
４．Present status with the name of the university attended or employer
(写真(4.5cm×3.5cm))
（現職（在学大学名又は勤務先名まで記入すること｡））
５．Present address and telephone number, facsimile number, e-mail address
（現住所及び電話，ファックス番号，E-mail アドレス）
現住所(Present address）：
電話番号/FAX 番号(Telephone/facsimile number）
：
E-mail address：
* If possible, write an e-mail address that can be used for periods including the time before you come to Japan, your stay in Japan and the period after
you return home.
（可能な限り、渡日前～日本留学中～帰国後にわたり使い続けることが予想される E-mail アドレスを記入すること。）
６．Field of specialization studied in the past（Be as detailed and specific as possible.)
（過去に専攻した専門分野（できるだけ具体的に詳細に書くこと｡））
－1－
７．Educational background （学歴）
Name and Address of School
（学校名及び所在地）
Year and Month
of Entrance and
Completion
(入学及び卒業年月)
Amount of time
spent at the
school attended
（修学年数）
Name
(学校名)
From
（入学）
years
（年）
Location
(所在地)
To
（卒業）
and
months
（月）
Name
(学校名)
From
（入学）
years
（年）
Location
(所在地)
To
（卒業）
and
months
（月）
Name
(学校名)
From
（入学）
years
（年）
Location
(所在地)
To
（卒業）
and
months
（月）
Name
(学校名)
From
（入学）
years
（年）
Location
(所在地)
To
（卒業）
and
months
（月）
Name
(学校名)
From
（入学）
years
（年）
Location
(所在地)
To
（卒業）
and
months
（月）
Diploma or Degree awarded,
Major subject
（学位・資格，専攻科目）
When taking leave of absence, the
period and reason.
（休学した場合はその期間・理由）
Elementary Education
(初等教育)
Elementary School
（小学校）
Secondary Education
（中等教育）
Lower Secondary School
（中学）
Upper Secondary School
（高校）
Higher Education
（高等教育）
Undergraduate Level
（大学）
Graduate Level
（大学院）
Total years of schooling mentioned above
（以上を通算した全学校教育修学年数）
as of April 1,2015
（2015 年 4 月 1 日現在）
years
（年）
* If the blank spaces above are not sufficient for the information required, please attach a separate sheet．
((注) 上欄に書ききれない場合には，適当な別紙に記入して添付すること｡)
８．State the titles or subjects of books or papers (including graduation thesis authored by the applicant), if any, with the name and address of the publisher and
the date of publication.（著書，論文（卒業論文を含む｡）があればその題名，出版社名，出版年月日，出版場所を記すこと｡）
－2－
９．Employment Record: Begin with the most recent employment, if applicable.（職歴）
Name and address of organization
Period of employment
Position
Type of work
（勤務先及び所在地）
（勤務期間）
（役職名）
（職務内容）
From
To
From
To
10．Japanese language proficiency: Evaluate your level and insert an X where appropriate in the following blank space.
（日本語能力を自己評価のうえ，該当欄に×印を記入すること｡）
Excellent
（優）
Good
（良）
Fair
（可）
Poor
（不可）
Fair
（可）
Poor
（不可）
Reading
（読む能力）
Writing
（書く能力）
Speaking
（話す能力）
11．Foreign language proficiency: Evaluate your level and insert an X where appropriate in the following blank space.
（外国語能力を自己評価のうえ，該当欄に×印を記入すること｡）
Excellent
（優）
Good
（良）
English
（英語）
French
（仏語）
German
（独語）
Spanish
（西語）
12．Have you been awarded a Japanese Government (Monbukagakusho) Scholarship in the past? If so, please specify the period, the name of the university, etc.
（過去に国費留学生に採用されたことがあるか。あるならば，その期間・受入大学名等を記入のこと。）
ⅰ) Yes, I have.
（ある）
Period:
University:
ⅱ) No, I have not.
（ない）
13．Accompanying Dependents (Provide the following information if you plan to bring any family members to Japan.)
同伴家族欄（渡日する場合，同伴予定の家族がいる場合に記入すること。）
* All expenses incurred by the presence of dependents must be borne by the grantee. He/She is advised to take into consideration various difficulties and
the great expense that will be involved in finding living quarters. Therefore, those who wish to be accompanied by their families are advised to come alone
first and let their dependents come after suitable accommodation has been found.
(
（注）なお同伴者に必要な経費はすべて留学生の負担であるが，家族用の宿舎をみつけることは相当困難であり賃貸料も非常に割高になるの
であらかじめ承知されたい。このため，留学生はまず単身で来日し，適当な宿舎をみつけた後，家族を呼び寄せること。
Name
（氏
Relationship
名）
(続柄)
－3－
Age
（年
齢）
)
14. Person to be notified in applicant's home country in case of emergency:
(緊急の際の母国の連絡先)
ⅰ） Name in full:
（氏名）
ⅱ） Address: with telephone number, facsimile number, e-mail address
（住所：電話番号，ファックス番号及び E-mail アドレスを記入のこと｡）
現住所(Present address)：
電話番号/FAX 番号(Telephone/Facsimile number）：
E-mail address：
ⅲ） Occupation:
（職
業）
ⅳ） Relationship:
（本人との関係）
15.Immigration Records to Japan（日本への渡航記録）
Date（日付）
Purpose（渡航目的）
From
To
From
To
（I understand and accept all the matters stated in the Application for Japanese Government(MONBUKAGAKUSHO:MEXT) Scholarship for 2015, and
hereby apply for this scholarship。
（私は 2015 年度日本政府（文部科学省）奨学金留学生募集要項に記載されている事項をすべて了解して申請します）
Date of application:
（申請年月日）
Applicant's signature:
（申請者署名）
Applicant's name
（in Roman block capitals）：
（申請者氏名）
－4－
APPLICATION QUESTIONNAIRE
For students who intend to study in ENGLISH. Please fill in electronically.
1. Name (As appears on your passport):
2. Birthday:
YY
MM
DD 3. Nationality:
4. Do you have Japanese citizenship?
Yes, I do.
No, I don’t.
5．Field of study in Japan (you’re desired thesis topic at Ritsumeikan):
______________________________________________________________________________
6. Study program at Ritsumeikan: The Graduate School of Economics
Master's Program in Economic Development (MPED)
Major Field: _______________________________________
Level: Select one
*IF you selected Master’s or Doctoral Degree Program for Level, SKIP TO QUESTION 7.
If you selected Research Only (Master’s Level) or Research Only (Doctoral Level), select your plan
following the conclusion of your research term:
a) I only intend to conduct research, so I will return home after completing my research term.
b) I will apply for, and try to gain admissions in order to progress into a Master’s Degree Course.
c) I will apply for, and try to gain admissions in order to progress into a Doctoral Degree Course.
*In order to become full-time degree seeking students, research students may, during their research term, take the entrance examination of the
graduate school in which they are enrolled. If this exam is passed, and all appropriate entrance procedures are completed, it is possible for
research students to become degree-seeking student at the same graduate school.
Notice: It may be possible for research students who have demonstrated exceptional grades and wish to enter into a Ritsumeikan University Master's
or Doctoral course to extend their scholarship award until the completion of their master's program (24 months) or doctoral program (36 months) if
they meet standards for enrollment and pass a rigorous evaluation by Monbukagakusho. (Scholarship extension in this case is not guaranteed.) In
addition, students already enrolled in a master's degree program who wish to progress to a Doctoral degree program at Ritsumeikan University may
be permitted to extend their scholarship award until the completion of a doctoral program (36 months) if they meet standards for enrollment and pass
a rigorous evaluation by Monbukagakusho. However, handling of extension applications varies based on individual programs.
7. Most recent Thesis Topic: If your current degree is in progress, but you have not yet determined
your thesis topic, please enter the information for your previous degree thesis.
Have you written a thesis?
Yes, I have.
No, I’ve never written a thesis.
If yes: Degree Level: ____________
Topic: _________________________________________
APPLICATION QUESTIONNAIRE
For students who intend to study in ENGLISH. Please fill in electronically.
8. Your desired supervising professor and your contact status.
Name of Professor:
Have you contacted him/her?
Yes, I have been in contact with this professor.
No.
*Applicants to the Graduate Schools of Science and Engineering, Information Science and Engineering, or Life
Sciences should make every effort to enter the name of a desired supervising professor.
9. Have you applied to other universities for a MEXT scholarship?
Yes.
No.
If yes: Name of University(ies):
10. If you are applying for any other (non-MEXT) scholarships, state the name of the
sponsor, duration, amount, etc.
Scholarship sponsoring Institution:
Scholarship period:
YY
MM ~
YY
MM
Amount:
Release date of scholarship application results:
YY
MM
DD
11. Name the nearest international airport to your home (must be in your country of nationality):
Airport
12. Name the city with the nearest Japanese embassy or consulate to your home where you
could obtain a Japanese visa (must be in your country of nationality):
____________________________________________________________
13. In the event that your application for Monbukagakusho funded studies is not successful,
do you wish to enter Ritsumeikan as a self-financed student? (The student pays for their own
academic fees and tuition) *Only for students who did not select Research Only in question 6, above.
Yes, I would.
No, I wouldn’t.
＜＜End of Questionnaire＞＞
（別紙）
専攻分野及び研究計画
Field of Study and Study Program
Full name in native language
（姓名（自国語））
(Family name)
，
(First name)
(Middle name)
Nationality
（国
籍）
Proposed study program in Japan (State the outline of your major field of study on this side and the details of your study program on the backside of this
sheet in concreteness. This section will be used as one of the most important references for selection. Statement must be typewritten or written in block
letters. Additional sheets of paper may be attached if necessary.)
(
)
日本での研究計画；この研究計画は，選考の重要な参考となるので，表面に専攻分野の概要を，裏面に研究計画の詳細を具体に記入すること。
記入はタイプ又は楷書によるものとし，必要な場合は別紙を追加してもよい。
If you have Japanese language ability, write in Japanese.
（相当の日本語能力を有する者は，日本語により記入すること｡）
１
Field of study（専攻分野）
２
Study program in Japan in detail and concreteness（研究計画：詳細かつ具体に記入すること｡）
健康診断書
CERTIFICATE OF HEALTH (to be completed by the examining physician)
日本語又は英語により明瞭に記載すること。
Please fill out (PRINT/TYPE) in Japanese or English.
氏名
Name:
,
Family name,
First name
□男 Male
□女 Female
Middle name
生年月日
Date of Birth:
年齢
Age:
１．身体検査
Physical Examination
(1) 身長
Height
体重
Weight
cm
(2) 血圧
Blood pressure
mm/Hg～
(3) 視力
Eyesight: (R)
(L)
裸眼 Without glasses
(4) 聴力
Hearing:
kg
mm/Hg
血液型
Blood type A B O
(R)
(L)
矯正 With glasses or contact lenses
□正常 normal
□低下 impaired
RH
＋
脈拍
－
□整 regular
Pulse □不整 irregular
□正常 normal
色覚異常の有無
□異常 impaired
Color blindness
言語 □正常 normal
Speech: □異常 impaired
２．申請者の胸部について，聴診とＸ線検査の結果を記入してください。Ｘ線検査の日付も記入すること（６ヶ月以上前の検査は無効｡)
Please describe the results of physical and X-ray examinations of the applicant's chest x-rays (X-rays taken more than
6 months prior
to this certification are NOT valid).
心臓
□正常 normal
Cardiomegaly: □異常 impaired
↓
← Date
異常がある場合
Film No.
心電図 Electrocardiograph :□正常 normal
□異常 impaired
Describe the condition of applicant's lungs.
肺
Lungs:
□正常 normal
□異常 impaired
３．現在治療中の病気
□Yes (Conditions/particulars:
Under medical treatment at present □No
)
４．既往症
Past history : Please indicate with ＋ or － and fill in the date of recovery
Tuberculosis......□( . .
)
Malaria.......□( . . )
Other communicable disease......□(
Epilepsy......□( . . )
Kidney disease.....□( . . )
Heart disease......□( . . )
Diabetes......□( . . )
Drug allergy......□( . . )
Psychosis.....□( . . )
Functional disorder in extremities......□( . . )
５．検査 Laboratory tests
検尿 Urinalysis: glucose (
赤沈 ESR:
), protein (
mm/Hr, WBC count:
Hemoglobin:
gm/dl, GPT:
), occult blood (
/cmm
.
.
)
)
貧血 □
anemia
６．志願者の既往歴，診察・検査の結果から判断して，現在の健康の状況は充分に留学に耐えうるものと思われますか？ Yes又はNoにチェックをし
てください。
In view of the applicant's history and the above findings, is it your observation that his/her health status is adequate to pu
rsue studies in Japan?
Yes □
No □
７．特記すべき事項
Particulars or additional comments:
日付
Date:
署名
Signature:
医師氏名
Physician's Name (Print):
検査施設名
Office/Institution:
所在地
Address:

Download Report