Hosei University Exchange Students from Overseas Program Application Form
法政大学交換留学生受け入れプログラム(ESOP)願書
2015-2016
Year 201㻞-2013
Should be typed or filled in with block letters
□ Exchange student 交換留学生
Attach recently
taken identity
photograph
□ Other (Privately-financed) 私費
4.5cm×3.5cm
Period of study at Hosei 本学での在籍期間
Full Academic Year
□ Year 1 年 (Apr- Mar 4-3 月)
□ Year 1 年 (Sep- Aug 9-8 月)
One Semester
□ Spring Semester 春学期 (Apr-Sep 4-9 月)
□ Fall Semester 秋学期 (Sep-Feb 9-2 月)
Full name (in native language)
氏名 （母国語）
(Surname)
(Given name)
(Middle name)
Full name (in alphabet)
氏名 （英語）
(Surname)
(Given name)
(Middle name)
Full name (in katakana)
氏名 （カタカナ）
(Surname)
(Given name)
(Middle name)
Date of birth
生年月日
(Month)
Nationality
国籍
(Day)
(Year)
Age
年齢
Sex (Male/ Female)
性別 ( 男･ 女)
Native language
母語
Marital status (Married / Single)
婚姻関係 ( 既婚 /
未婚)
Your current address 現住所
Tel:
Email
@
Your permanent / home address (if different from the above) 本国住所
Tel.:
Home institution
在籍大学
College/Faculty
学部
Current year of study
学年 (1st / 2nd / 3rd / 4th / Other
Department
学科
Main area of study (Major)
専攻
Expected date of graduation at home institution
卒業見込み日
GPA score on 4.0 scale
(where applicable):
)
Personal Statement
(1) Academic Achievements and Honors 学業における業績・表彰
Ex)
University Honor Role, Spring 2010
Regents Scholarship, Academic Year 2009
(2) School / Community Activities 学校・地域での活動
Ex)
Treasurer of the Botany Club, September 2009 to June 2010
Community Worker in the Assist the Elderly Week April 1- 8 2010
Proposed status at Hosei University 希望する法政大学の学部または研究科
Undergraduate 学部生
Graduate 大学院生
(Please choose one/一つ選んでください)
College/Faculty 学部
Department 学科
Proposed main area of study (Major) 専攻
Japanese Course (Please circle appropriate level) 受講したい日本語授業のレベル
Elementary
/
Intermediate
/
Advanced
/
Japanese-Language Proficiency Test (if you have taken it)
Level
Score
Regular Course
日本語能力試験 （受けたことのある方）
Year
Learning Experience of Japanese Language 日本語の学習歴
Period (months) 期間
Institution 学校
For reference, in the space allotted below, please note down the Japanese language texts you have used.
日本語学習時に使用した教材
Period (months) 期間
Name of text 教材の名前
Japanese Language Proficiency 日本語能力
Reading:
読解
□ Excellent
優れている
□ Good
□ Average
やや優れている 普 通
□ Below Average
やや劣る
□ Poor
劣る
Writing:
作文
□ Excellent
優れている
□ Good
□ Average
やや優れている 普 通
□ Below Average
やや劣る
□ Poor
劣る
Speaking /Listening: □ Excellent
会話
優れている
□ Good
□ Average
やや優れている 普 通
□ Below Average
やや劣る
□ Poor
劣る
Previous Experience in Japan (if any) 日本滞在歴
Period (Months) 時期・期間
Place 場所
Proposed ESOP Lectures (code / lecturer/ titles)
Purpose 目的
ESOP で受講したい科目
1. _______________/ _____________________________/ _______________________________________________________________________________________
2 ______________/ _____________________________/ _______________________________________________________________________________________
3. ______________/ _____________________________/ _______________________________________________________________________________________
4. ______________/ _____________________________/ _______________________________________________________________________________________
5. ______________/ _____________________________/ _______________________________________________________________________________________
6. ______________/ _____________________________/ _______________________________________________________________________________________
7. ______________/ _____________________________/ _______________________________________________________________________________________
8. ______________/ _____________________________/ _______________________________________________________________________________________
9. ______________/ _____________________________/ _______________________________________________________________________________________
English Language Proficiency 英語能力
Reading:
読解
□ Excellent
優れている
□ Good
□ Average
やや優れている 普 通
□ Below Average
やや劣る
□ Poor
劣る
Writing:
作文
□ Excellent
優れている
□ Good
□ Average
やや優れている 普 通
□ Below Average
やや劣る
□ Poor
劣る
Speaking /Listening: □ Excellent
会話
優れている
□ Good
□ Average
やや優れている 普 通
□ Below Average
やや劣る
□ Poor
劣る
English Language Proficiency (if you have taken it) 英語能力試験 （受けたことのある方）
TOEFL/TOEIC/IELTS/OTHER Score:
Year:
Housing Arrangements 宿舎について
Please indicate, by circling the relevant alternative, whether you would like: (1) Arrangements for
accommodation provided by Hosei University 法 政 が 手 配 す る 宿 舎 (2) Your own accommodation
arrangements, at your own responsibility 自己手配.
*Costs may vary according to the yearly based revised contract between Hosei University and an
external private organization.
(1) Hosei arranged accommodation 法政が手配する宿舎
(2) Personal arrangement 自己手配
(Please choose one/一つ選んでください)
Address in case of personal arrangement
自己手配の場合の住所
Evidence of means of support while in Japan 滞在中の財政的支援
Own funds: US$
Parents’/ Spouses’ funds: US$
Other(s) (give details, including your relationship to the source of funds):
US$
Relationship
Total: US$
In order for the International Center of Hosei University to obtain a Certificate of Eligibility from
the Ministry of Justice on your behalf, it is necessary to have evidence regarding your means of support
while in Japan, so far as possible. Please provide specific information of funds which may be available, if
necessary, to meet your living expenses while in Japan. Please attach also the supporting documentation.
(e.g. bank certificate etc.)
I certify that the above statement is true and correct to the best of my knowledge.
上記の通り相違ありません。
Date
(Month)
記入年月日
(Day)
(Year)
Signature
署
名
Study at Hosei University
Within the allotted space below, please explain in 日本語 or English: 1) why you think it is necessary for
you to study at Hosei University, 2) how your system of values and life experiences will help you succeed
as a Hosei student and 3) what kind of cultural and/or educational exchanges you would like to participate
in while studying in Japan and how they may help you achieve your future educational and career goals.
（This section must be typed. If you are unable to type on this form itself, please complete the requested
information on two separate sheets of paper, double-spaced.）

Fellowship《Invitation》Application Form