Application for Individual Assessment of Admission Eligibility Tokyo Institute of Technology Global Scientists and Engineers Program Commencing in April 2018 *This form is only for applicants who are requesting Individual Assessment of Admission Eligibility (a) as outlined in Section 4 (Individual Assessment Prior to Application) in this application guide. Required documents: -Graduation certificate and transcript of high school -Admission certificate of university -Certificate of university student status and transcript To the president of Tokyo Institute of Technology This is to certify that I wish to apply for the Tokyo Institute of Technology’s Global Scientists and Engineers Program, and, having attached the required documents, request Individual Assessment for eligibility to apply. 1.Name in full in Roman block capitals 2.Sex Male  Female  (Family name) (First name) (Middle name) 3.Date of birth ( Year Age(as of April 1, 2018)) ( ) Tel Present ( ) Fax Address Email Academic background Year and Month Diploma or Degree awarded, Name and Address of School of Entrance and Duration of Attendances Major Subject, Skipped Completion years/levels Elementary Education From years Name and Location Elementary School To months Secondary Education From years Name and Location Lower Secondary School To months *1 From years Name Upper Secondary School and Location To months Higher Education Name From years and Location Undergraduate Level To months years Total of the years schooling mentioned above and As of April 1, 2018 months Please send this form and required documents by to Admissions Division (Undergraduate), Student Service Department, of Tokyo institute of technology. Email address: nyu.gak@jim.titech.ac.jp Notes: 1. Exclude kindergarten education and nursery school education. 2. Preparatory education for university admission is included in secondary education. 3. If the applicant has passed the university entrance qualification examinations, indicate this in the
Application for Individual Assessment of Admission Eligibility Tokyo Institute of Technology Global Scientists and Engineers Program Commencing in April 2018 *This form is only for applicants who are requesting Individual Assessment of Admission Eligibility (a) as outlined in Section 4 (Individual Assessment Prior to Application) in this application guide. Required documents: -Graduation certificate and transcript of high school -Admission certificate of university -Certificate of university student status and transcript To the president of Tokyo Institute of Technology This is to certify that I wish to apply for the Tokyo Institute of Technology’s Global Scientists and Engineers Program, and, having attached the required documents, request Individual Assessment for eligibility to apply. 1.Name in full in Roman block capitals 2.Sex  Male  Female (Family name) (First name) (Middle name) 3.Date of birth ( Year Age(as of April 1, 2018)) Present Address Tel Fax Email ( ) ( ) Academic background Name and Address of School Year and Month of Entrance and Completion Duration of Attendances Diploma or Degree awarded, Major Subject, Skipped years/levels Elementary Education Elementary School Name Location From To years and months Secondary Education Lower Secondary School Name Location From To years and months Upper Secondary School Name Location From To years and months *1 Higher Education Undergraduate Level Name Location From To years and months Total of the years schooling mentioned above As of April 1, 2018 years and months Please send this form and required documents by to Admissions Division (Undergraduate), Student Service Department, of Tokyo institute of technology. Email address: nyu.gak@jim.titech.ac.jp Notes: 1. Exclude kindergarten education and nursery school education. 2. Preparatory education for university admission is included in secondary education. 3. If the applicant has passed the university entrance qualification examinations, indicate this in the
assesment_admission_Eligibility_2018.docx