en.ritsumei.ac.jpen.ritsumei.ac.jp/ise-e/pr/file/isse_apr_af.docx · web viewen.ritsumei.ac.jp

APPLICATION FORMS2018 Entry: April AO Admissions for International Students [English Basis]

DOCUMENT CHECKLISTTHIS BOOKLET CONTAINS THE FOLLOWING FORMS. SUBMIT ALL FORMS.☐ 0 Document Checklist (this form)☐ 1 Registration Form ①☐ 2 Registration Form ②☐ 3 Registration Form ③☐

4Two Letters of Reference Must be confidential. Each must be signed and sealed by the referee.

☐ 5 Application EssaysCERTIFICATES AND OTHER DOCUMENTS YOU MUST SUBMIT☐ 6* University Entrance Eligibility Document(s)

Check the document(s) you are submitting. Document(s) must be ORIGINAL

☐ Certificate of high school graduation

☐ Certificate of scheduled high school graduation

☐ Official certificate of completion of secondary education

☐ Document(s) proving that you hold a recognized university entrance qualification

☐ Document(s) proving that you have passed a high school equivalency exam

☐ Other: please specify:

☐ 7* Academic TranscriptsCheck the document(s) you are submitting. Document(s) must be ORIGINAL

☐ Academic transcripts for your most recent 3 years of high school or senior secondary education

☐ Certificate of standardized examination results for university entrance, such as SAT, ACT etc


☐ 8 English Proficiency Test Score ReportCheck the document(s) you are submitting.

☐ TOEFL iBT® Test / TOEFL® PBT Test Submit either one of the followings.

☐ A photocopy of the Test Taker Score Report (Examinee Score Report)

☐ A printout of the “View Scores” from ETS website.

☐ A photocopy of the TOEIC® L&R Test Official Score Certificate

☐ A photocopy of the IELTS (Academic Module) Test Report Form

☐ Proof stating that the medium of instruction of your most recent 6 years of full-time academic studies was English,

Please specify: (e.g. Letter from high

school)

☐ 9 Optional: Math, Science, and Computer Programming Award Documents

AO-41

(including the issuer contact details)10 Evidence of Application Fee Payment

☐ Check the document(s) you are submitting

☐ A photocopy of the bank remittance application form/receipt

☐ A printout of the credit card payment “Transaction Confirmation” from the “e-apply” website

☐ 11 Photocopy of Passport　Check the document(s) you are submitting

☐ A photocopy of the page of your passport showing the photo, name and passport number

☐ A photocopy of another official certificate of your country (e.g. birth certificate or an official registry)

Please specify:

☐ Additionally, a photocopy of the Residence Card for those without Japanese nationality and living in Japan

☐

12 1 Photograph (3 cm x 2.4 cm)　Check below

☐ Wrote your name and nationality in English on the back of the photograph

☐ Attached to the Registration Form ①

*A photocopy of the original documents will not be accepted.

AO-4

APPLICATION MUST BE SENT TOInternational Admissions OfficeRitsumeikan University56-1 Tojiin Kitamachi, Kitaku Kyoto603-8577 (or 603-8346) JapanPhone: +81-75-465-8162

IMPORTANTDO NOT SEND APPLICATION BY REGULAR MAILUse courier service (DHL, FedEx, Ups, etc.) from outside Japan. Use 簡易書留速達 in Japan

2

Personal Information Policy

Personal information collected from individuals during the admissions process will be handled in accordance with

the following.

1. Purpose of Use of Personal Information① To carry out the admissions process, such as screening, mailing interview information sheets,

holding interviews, etc.

② To notify results

③ To send enrollment-related documents

④ To make documents relating to the Certificate of Eligibility

⑤ To send information regarding orientation sessions for international students

⑥ To send information regarding student life, such as housing, insurance, National Federation of

University Co-operative Associations, etc.

⑦ To send various questionnaires after admission

⑧ To manage student records after their enrollment

2. Management of Personal InformationRitsumeikan University will manage the personal information of applicants in compliance with relevant

Japanese laws and regulations. Information will be managed securely to prevent loss, destruction or

divulgence.

3. Outsourcing of the Handling of Personal InformationRitsumeikan University may outsource part of the handling of the personal information of applicants when

necessary, such as the receipt of applications or the data entry of personal details. In such cases,

Ritsumeikan University and the external organization will sign a contract regarding the appropriate

management of personal information.

4. Statistical Use of Personal InformationRitsumeikan University may use data extracted from applicants’ personal information to conduct various

statistical analyses to be used for surveys and research relating to the admission process. This data may

also be provided to students interested in applying to Ritsumeikan University. However, the University

shall ensure that any information made public cannot be used to identify specific individuals.

AO-43

1 Registration Form ①Please print in BLOCK LETTERS I. Desired Semester of Enrollment

2018 April

II. ProgramCollege Department

The College of Information Science and Engineering Department of Information Science and Engineering

*Students of this program will be enrolled in the Information Systems Science and Engineering Course.III. Applicant Information

Name in English　　　　　　　　　　　　　　　　　　　　　

Use all CAPITAL LETTERS for your Surname. Capitalize the first letters of your first and middle name.

e.g.

Sex Surname Given Name (including Middle Name)

☐ Male

☐ FemaleRITSUMEI Jonathan Michael

Name Sex Surname Given Name (including Middle Name)

English Alphabet☐ Male

☐ Female

Name in Kana and Kanji (for Japanese Nationality Holders only)名前姓名

カタカナ Kana

漢字 Kanji

Nationalities/ Date of Birth /Native Language/ Date of High School GraduationNationalities

Please write all Date of Birth

Year Month Date

Native

Language

Date of High School

Graduation

Year Month

Status of Residence in Japan

Status of

Residence in

Japan

Do you have

a status of

residence

in Japan?

☐ YESIf Yes, specify

your status

Valid

Until

Year Month Date

☐ NoIf No, do you wish Ritsumeikan University to apply for the Certificate of

Eligibility for Status of Residence on your behalf?

☐ YES

☐ No

Contact Details Critical communications with the applicant, such as interview information and result notification, will be sent to the address below.

＊If you will be staying in a different place from the address below for the interview date, notify us of both addresses.

＊If you are living in Japan, write details in Japanese.

Mailing

AddressPostal Code: Country:

AO-4

Attacha photo here3cm x 2.4cm

4

For University Use2018 AO-4 ( ISSE-S1 )受験番号: 願書受付日:

Phone Home Phone: Cell Phone:

E-Mail SKYPE ID

Guardian’s Contact Details ＊If your guarantor is Japanese and/or living in Japan, write details in Japanese＊

Guardian’s

Contact

(Emergency

Contact)

NameRelationship

with Applicant

Address

Postal Code: 　　　　　　Country: Phone

AO-45

2 Registration Form②IV. English ProficiencyPlease mark the test scores that you are submitting

Check the Report You are

submitting

Check as necessary before submitting the report

☐ TOEFL iBT® Test ☐ I enclosed a photocopy of the Test Taker Score Report (Examinee Score Report)*

☐ I enclosed a printout of the “View Scores” from ETS website.☐ TOEFL® PBT Test

☐ TOEIC® L&R Test Official Score Certificate ☐ I enclosed a photocopy of the TOEIC® L&R Test Official Score Certificate

☐ IELTS (Academic Module) Test Report Form ☐ I enclosed a photocopy of the IELTS (Academic) Test Report Form

☐ Medium of my most recent 6 years of full-time

academic studies is/was English

☐ I enclosed ** to prove that my most recent 6 years of full-

time

academic studies have been conducted in English, which was the official language of instruction.

* TOEFL® Test Taker Score Report is the report ETS dispatches to the test taker.

** e.g. a letter from your school with signature of principal/the school stamp, using official letterhead

V. Application FeePlease indicate the payment method for the application fee and fill in the blanks where required.

Applications will not be accepted without payment of the Application Fee.

Check the payment method You used Check items

☐ Overseas Remittance

☐ I enclosed a copy of remittance receipt

Remittance Date: Sender’s

Name：

☐ Domestic Remittance (within Japan)



Name：

☐ Credit Card Transaction

☐ I enclosed a copy of “Transaction Confirmation”

Transaction Date:

VI. Application for Tuition Reduction Scheme “Ritsumeikan University Special Encouragement Scholarship for Privately Financed International Students” is the tuition reduction

scheme offered to international students with outstanding results. Through this scholarship, Ritsumeikan University aims to

encourage international students to excel in their studies, and become active role models for other students.

To apply for this scholarship, international students must meet both of the following requirements.

1) Students must possess the status of residence of “Student” by the time of enrollment.

2) Students need financial support from the University to pursue their studies at the University

AO-4

NAME:

6

With full understanding of the above concepts, please answer following questions for our reference.

Question Answer

1Do you wish to apply for the “Ritsumeikan University Special Encouragement Scholarship for

Privately Financed International Students”?☐ Yes ☐ No

2Do you intend to hold the status of residence of “Student” during your studies at Ritsumeikan

University?☐ Yes ☐ No

VII. Declaration and SignatureI hereby declare that all of the information I have provided is true and that the documents I have submitted are not forgeries.

If any forgeries or false information are found before or after enrollment, I understand that my acceptance will be revoked, and no

appeals will be allowed under any circumstances.

3 Registration Form③VIII. Official EducationPlease 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.

Name of SchoolSchool

Category

Medium of

Instruction

School Address

(City, Country)

Period of AttendanceYears

AttendedStart Date End Date

Year Month Year Month

ABCD Elementary School Elementary Japanese Tokyo, Japan 2006 4 2011 8 5

EFGH International School Elementary English Hawaii, USA 2011 9 2012 6 1

EFGH International Middle School Middle English Hawaii, USA 2012 9 2015 6 3

IJKL Foreign Language High

SchoolSenior High Korean Seoul, ROK 2015 6 2018

2

prospecti

ve

3

AO-4

NAME:

7

Date: Signature:

Total Years of Education: ( ) years

IX. Other Attended SchoolsPlease list any other schools that you have attended (e.g. language schools, specialized institutions).


Category

Medium of

Instruction

School Address

(City, Country)




X. Employment HistoryIf 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 Title

Period of Work

From To


AO-48

BLANK PAGE

AO-49

4 Letter of Reference 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 DetailsName Occupation

School/

Organization

Name

School/

Organization

Address Postal Code: Country:

Phone Number E-Mail

II. Applicant Evaluation1. 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 checking the box (☑) for the appropriate number:Low --------------------- High

Academic ability ☐1 ☐2 ☐3 ☐4 ☐5 Unable to Comment

Diligence ☐1 ☐2 ☐3 ☐4 ☐5 Unable to Comment

Math Knowledge ☐1 ☐2 ☐3 ☐4 ☐5 Unable to Comment

Science Knowledge ☐1 ☐2 ☐3 ☐4 ☐5 Unable to Comment

Communication skills ☐1 ☐2 ☐3 ☐4 ☐5 Unable to Comment

Extracurricular activities ☐1 ☐2 ☐3 ☐4 ☐5 Unable to Comment

Overall assessment of applicant ☐1 ☐2 ☐3 ☐4 ☐5 Unable to Comment

5. Please make further comments on the personality 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.)

AO-410

Before returning this form to the applicant, please put the complete form in an envelope, seal it, and sign your

name or place the official stamp across the seal.

If you have any questions regarding this form, please contact the International Admissions Office at Ritsumeikan University.

Tel:+81-75-465-8162 E-mail: [email protected]

4 Letter of Reference MUST NOT BE FILLED IN BY THE APPLICANT



2. Please date and sign this form.




I. Your DetailsName Occupation

School/

Organization

Name

School/

Organization

Address Postal Code: Country:

Phone Number E-Mail



3. In what capacity do you know the applicant? (e.g. teacher from the high school)







AO-411

Date: Signature:




5. Please make further comments on the personality 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.)


name or place the official stamp across the seal.



AO-412

Date: Signature:

BLANK PAGE

AO-413

5 Application Essays

IMPORTANT

Each essay has a word limit (Essays 1 & 2, 300 words each; 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.

ISSE Essay 1:Describe reason(s) you would like to enter the International Program of Information Systems Science and Engineering at Ritsumeikan University. (300 words)

ISSE Essay 2:Write about school or learning experiences that you are proud of, and how they influenced your desire to study at university. (300 words)

ISSE Essay 3:Select an issue society is currently facing, give its background, and describe your own ideas about how science and technology would help solve the issue. (600 words)

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.

AO-414

ISSE Essay 1:

Describe reason(s) you would like to enter the International Program of Information Systems Science and Engineering at Ritsumeikan University. (300 words)

Word /300 Date Signatu

AO-4

NAME:

15

Count: : re:


AO-4

NAME:

16

Word Count:

/300 Date:

Signature:

ISSE Essay 3:Select an issue society is currently facing, give its background, and describe your own ideas about how science and technology would help solve the issue.(600 words)IMPORTANT





AO-4

NAME:

Page 117

AO-418

Word Count:

/600 Date:

Signature:

APPLICATION FORMS2018 Entry: Recommendation Admissions [English Basis]

DOCUMENT CHECKLISTTHIS BOOKLET CONTAINS THE FOLLOWING FORMS. SUBMIT ALL FORMS.☐ 0 Document Checklist (this form)☐ 1 Registration Form ①☐ 2 Registration Form ②☐ 3 Registration Form ③☐

4Letter of Reference from Principal Must be confidential. Must be signed and sealed by the Principal of your high school.

☐ 5 English Proficiency Evaluation Form Submit this form if you cannot submit other English Proficiency Score Report indicated in

section 9.Must be filled in by an English teacher from the applicant’s high school. Must be confidential and sealed by the

evaluator.

☐ 6 Application Essays

CERTIFICATES AND OTHER DOCUMENTS YOU MUST SUBMIT☐ 7* Certificate of (Scheduled) High School Graduation

Check the document(s) you are submitting. Documents must be ORIGINAL

☐ Certificate of high school graduation

☐ Certificate of scheduled high school graduation


☐ 8* Academic TranscriptsCheck the document(s) you are submitting. Documents must be ORIGINAL

☐ Original academic transcripts for your most recent 3 years of study from the high school


AO-4Page 2

NAME:

19

☐ 9 English Proficiency Test Score ReportCheck the document(s) you are submitting.

☐ TOEFL iBT® Test / TOEFL® PBT Test Submit either one of the followings.

☐ A photocopy of the Test Taker Score Report (Examinee Score Report)

☐ A printout of the “View Scores” from ETS website.

☐ A photocopy of the TOEIC® L&R Test Official Score Certificate

☐ A photocopy of the IELTS (Academic Module) Test Report Form

☐ English Proficiency Evaluation Form

☐ 10Optional: Math, Science, and Computer Programming Award Documents (including the issuer contact details)

11 Evidence of Application Fee Payment☐ Check the document(s) you are submitting

☐ A photocopy of the bank remittance application form/receipt

☐ A printout of the credit card payment “Transaction Confirmation” from the “e-apply” website

☐ 12 Photocopy of PassportCheck the document(s) you are submitting

☐ A photocopy of the page of your passport showing the photo, name and passport number

☐ A photocopy of another official certificate of your country (e.g. birth certificate or an official registry)

Please specify:

☐ Additionally, a photocopy of the Residence Card for those without Japanese nationality and living in Japan

☐

1 ３ 1 Photograph (3 cm x 2.4 cm)　Check below

☐ Wrote your name and nationality in English on the back of the photograph

☐ Attached to the Registration Form ①

*A photocopy of the original documents will not be accepted.

Personal Information Policy

Personal information collected from individuals during the admissions process will be handled in accordance with

the following.

5. Purpose of Use of Personal Information① To carry out the admissions process, such as screening, mailing admission registration cards,

holding interviews, etc.

② To notify results

③ To send enrollment-related documents

④ To make documents relating to the Certificate of Eligibility

⑤ To send information regarding orientation sessions for international students

AO-4

APPLICATION MUST BE SENT TOInternational Admissions OfficeRitsumeikan University56-1 Tojiin Kitamachi, Kitaku Kyoto603-8577 (or 603-8346) Japan Phone: +81-75-465-8162

IMPORTANTDO NOT SEND APPLICATION BY REGULAR MAILUse courier service (DHL, FedEx, Ups, etc.) from outside Japan. Use 簡易書留速達 in Japan

20

⑥ To send information regarding student life, such as housing, insurance, National Federation of

University Co-operative Associations, etc.

⑦ To send various questionnaires after admission

⑧ To manage student records after their enrollment

6. Management of Personal InformationRitsumeikan University will manage the personal information of applicants in compliance with relevant

Japanese laws and regulations. Information will be managed securely to prevent loss, destruction or

divulgence.

7. Outsourcing of the Handling of Personal InformationRitsumeikan University may outsource part of the handling of the personal information of applicants when

necessary, such as the receipt of applications or the data entry of personal details. In such cases,

Ritsumeikan University and the external organization will sign a contract regarding the appropriate

management of personal information.

8. Statistical Use of Personal InformationRitsumeikan University may use data extracted from applicants’ personal information to conduct various

statistical analyses to be used for surveys and research relating to the admission process. This data may

also be provided to students interested in applying to Ritsumeikan University. However, the University

shall ensure that any information made public cannot be used to identify specific individuals.

1 Registration Form ①Please print in BLOCK LETTERSI. Desired Semester of Enrollment

2018 April

II. ProgramCollege Department

The College of Information Science and Engineering Department of Information Science and Engineering

*Students of this program will be enrolled in the Information Systems Science and Engineering Course.

III. Applicant’s InformationAO-4

Attacha photo here3cm x 2.4cm

21

For University Use2018 RA – S ( ISSE-S1 )受験番号:

願書受付日:

Name in English

Use all CAPITAL LETTERS for your Surname. Capitalize the first letters of your first and middle name.

e.g.

Sex Surname Given Name (including Middle Name)

☐ Male

☐ FemaleRITSUMEI Jonathan Michael

Name Sex Surname Given Name (including Middle Name)

English Alphabet☐ Male

☐ Female

Name in Kana and Kanji (for Japanese Nationality Holders only)名前姓名

カタカナ Kana

漢字 Kanji

Nationalities/ Date of Birth /Native Language/ Date of High School GraduationNationalities

Please write all Date of Birth

Year Month Date

Native

Language

Date of High School

Graduation

Year Month

Status of Residence in Japan

Status of

Residence in

Japan

Do you have

a status of

residence

in Japan?

☐ YESIf Yes, specify

your status

Valid

Until

Year Month Date

☐ NoIf No, do you wish Ritsumeikan University to apply for the Certificate of

Eligibility for Status of Residence on your behalf?

☐ YES

☐ No

Contact Details Critical communications with the applicant, such as interview information and result notification, will be sent to the address below.

＊If you will be staying in a different place from the address below for the interview date, notify us of both addresses.

＊If you are living in Japan, write details in Japanese＊

Mailing

AddressPostal Code: Country:

Phone Home Phone: Cell Phone:

E-Mail SKYPE ID

Guardian’s Contact Details ＊If your guarantor is Japanese and/or living in Japan, write details in Japanese＊

Guardian’s

Contact

(Emergency

Contact)

NameRelationship

with Applicant

Address

Postal Code: 　　　　　　Country: Phone

AO-422

2 Registration Form②III. English ProficiencyPlease mark the test scores that you are submitting

Check the Report You are

submitting

Check as necessary before submitting the report

☐ TOEFL iBT® Test ☐ I enclosed a photocopy of the Test Taker Score Report (Examinee Score Report)*

☐ I enclosed a printout of the “View Scores” from ETS website.☐ TOEFL® PBT Test

☐ TOEIC® L&R Test Official Score Certificate ☐ I enclosed a photocopy of the TOEIC® L&R Test Official Score Certificate

☐ IELTS (Academic Module) Test Report Form ☐ I enclosed a photocopy of the IELTS (Academic) Test Report Form

☐ English Proficiency Evaluation Form☐ As I do not possess any score reports above, I enclosed the English Proficiency Evaluation Form

which was filled in, signed, and sealed by the English teacher from my high school.

* TOEFL® Test Taker Score Report is the report ETS dispatches to the test taker.

IV. Application FeePlease indicate the payment method for the application fee and fill in the blanks where required.

Applications will not be accepted without payment of the application fee.

Check the payment method You used Check items

☐ Overseas Remittance



Name：

☐ Domestic Remittance (within Japan)



Name：

☐ Credit Card Transaction

☐ I enclosed a copy of “Transaction Confirmation”

Transaction Date:

V. Application for Tuition Reduction Scheme “Ritsumeikan University Special Encouragement Scholarship for Privately Financed International Students” is the tuition reduction

scheme offered to international students with outstanding results. Through this scholarship, Ritsumeikan University aims to

encourage international students to excel in their studies, and become active role models for other students.

To apply for this scholarship, international students must meet both of the following requirements.

AO-4

NAME:

23

3) Students must possess the status of residence of “Student” by the time of enrollment.

4) Students need financial support from the University to pursue their studies at the University

With full understanding of the above concepts, please answer following questions for our reference.

Question Answer

1Do you wish to apply for the “Ritsumeikan University Special Encouragement Scholarship for

Privately Financed International Students”?☐ Yes ☐ No

2Do you intend to hold the status of residence of “Student” during your studies at Ritsumeikan

University?☐ Yes ☐ No

VI. Declaration and SignatureI hereby declare that all of the information I have provided is true and that the documents I have submitted are not forgeries.

If any forgeries or false information are found before or after enrollment, I understand that my acceptance will be revoked, and no

appeals will be allowed under any circumstances.

3 Registration Form③VII. Official EducationPlease 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.


Category

Medium of

Instruction

School Address

(City, Country)




ABCD Elementary School Elementary Japanese Tokyo, Japan 2006 4 2011 8 5

EFGH International School Elementary English Hawaii, USA 2011 9 2012 6 1

EFGH International Middle School Middle English Hawaii, USA 2012 9 2015 6 3

IJKL Foreign Language High

SchoolSenior High Korean Seoul, ROK 2015 6 2018

2

prospecti

ve

3

AO-4

NAME:

24

Date: Signature:

Total Years of Education: ( ) years

VIII. Other Attended SchoolsPlease list any other schools that you have attended (e.g. language schools, specialized institutions).


Category

Medium of

Instruction

School Address

(City, Country)




AO-425

BLANK PAGE

AO-426

4 Letter of Reference from Principal

MUST NOT BE FILLED IN BY THE APPLICANT



2. Please write the Principal’s name with a Principal’s stamp or school seal (official seal) on the bottom.




I. Details of the RefereeName Occupation

Phone Number E-Mail












9. 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.)

AO-4

Official Seal

27

Date: Principal’s name:

School name:


name or place the official seal across the seal.



AO-428

BLANK PAGE

AO-429

5 English Proficiency Evaluation Form

I. Notes to Evaluator1. Please assess the language proficiency of the below applicant objectively, in view of his/her ability for university

classes.

2. Please complete the entire form and sign at the bottom on the second page

3. Do not share your evaluation with the applicant. This form must be sealed in an envelope and returned to

the applicant.

4. Please attach your business card, if available.

II. Language Ability EvaluationPlease write the “Name of Applicant” below by the person who fills in this form.※

Please check the proficiency level of the applicant’s speaking, listening, writing, and reading1) Speaking 2) Listening

☐

The Applicant can fully demonstrate their English speaking

ability by;

- communicating effectively in English about various topics.

- speaking mostly in a clear and fluent manner.

- using appropriate vocabulary and grammar to explain concepts and

ideas.

☐

The Applicant can fully understand conversations and lectures in English that

present a wide range of listening demands.

They can understand difficult vocabulary, such as unusual phrases, informal words

or metaphors.

They can understand complex grammatical structures and complex ideas.

They can make sense of conversations/lectures with unexpected or contradictory

information

☐The Applicant can demonstrate their ability to speak in English about

certain topics with only minor communication problems.

Their speech is mostly clear and easy to understand.

They have some problems with pronunciation and intonation.

Their use of grammar and vocabulary is adequate, but some ideas are

not fully developed or are inaccurate

☐ The Applicant can understand most of the conversations and lectures in English

that present a wide range of listening demands.

They can understand difficult vocabulary, such as unusual phrases, informal words

or metaphors.

They can understand, though not consistently;

AO-4

Name of Applicant:

Must be filled in by an English teacher from the applicant’s high school.

Must be confidential and sealed by the evaluator

In your professional opinion, which score approximately would the applicant achieve if they were to take the TOEFL iBT?

points* / ☐ Unable to comment *Minimum TOEFL iBT® Score required to apply is 71 points.

*Minimum TOEFL iBT Score required to apply is 79 points.

30

- difficult vocabulary, such as unusual phrases, informal words or metaphors.

- complex grammatical structures and complex ideas.

They may have some difficulty making sense of conversations/lectures with

unexpected or contradictory information.

☐

The Applicant can use English to talk about the basic ideas, however,

often includes few relevant or accurate details.

They have problems with grammar, vocabulary and pronunciation.

They can respond in a general way to the questions, but provide only

limited information.

Their expression of ideas is often vague and unclear.

☐

The Applicant’s English speaking ability is limited.

They include little or no information about the topic.

The Applicant’s speech is often difficult for listeners to understand, and

the meaning is unclear.

☐ The Applicant can understand the main idea and some important details of

conversations. However, they do not understand lectures and conversations with

complex ideas or the relationship between those ideas.

They also do not understand sections of lectures and conversations with difficult

vocabulary or complex grammatical structures.

3) Writing 4) Reading

☐The Applicant can write a well-organized and developed essay.

Most of their writing is grammatical, clear and idiomatic.☐

The Applicant can understand texts in English regardless of the difficulty and have

a very good command of academic vocabulary and grammatical structure.

They can understand and connect information in complex texts.

☐

The Applicant can express ideas with reasons, examples and details in

their essay.

Their writing however, does not provide enough specific support and

development for their main points.

Their writing contains some grammatical mistakes or vague/ incorrect

uses of words.

☐

The Applicant can understand texts in English that require a wide range of reading

abilities, although their understanding of some parts is limited.

They have a good command of common academic vocabulary, but still have some

difficulty with high-level vocabulary.

They have a good understanding of grammatical structure.

They understand and connect information in general texts.

☐

Applicant’s response is judged as limited due to failure to understand the

lecture or reading passage, deficiencies in relating the lecture to the

reading passage, and/or many grammatical errors and/or very unclear

expressions and sentence structures.

☐The Applicant can understand some of the information presented in texts.

They have a command of basic academic vocabulary, but their understanding of

less common vocabulary is inconsistent.

■ Time period that you have taught the applicant From　　 (year/month) to　　　　　　　　　 (year/month)

■ Total hours the applicant has studied English in your school 　　　　　 hours

■ Please list the textbooks used in the English classes at your school.

Name of Textbook Chapter the applicant has finished

■ Please write any opinions relating to the applicant’s language abilities. Please describe the applicant’s

AO-4

PLEASE ALSO FILL IN THE REVERSE SIDE

31

strengths and weaknesses in their English proficiency.

III. Evaluator’s Details

Name Occupation/Title

Name of High

School

Address of High

School Postal Code: Country:

Phone Number E-Mail

The information provided above is based on my true and honest appraisal of the applicant’s English proficiency.

Date :

Signature:


name across the seal.



AO-432

6 Application Essays

IMPORTANT

Each essay has a word limit (Essays 1 & 2, 300 words each; 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.



ISSE Essay 3:Select an issue society is currently facing, give its background, and describe your own ideas about how science and technology would help solve the issue. (600 words)

IMPORTANT





AO-4

NAME:

33


Word /300 Date Signatu

AO-4

NAME:

34

Count: : re:


AO-4

NAME:

35

Word Count:

/300 Date:

Signature:

ISSE Essay 3:Select an issue society is currently facing, give its background, and describe your own ideas about how science and technology would help solve the issue. (600 words)IMPORTANT





AO-4

NAME:

Page 136

AO-437

Word Count:

/600 Date:

Signature:

AO-4Page 2

38