International Student Affairs Section

Nara Institute of Science and Technology (NAIST)

8916-5 Takayama, Ikoma, Nara, 630-0192 Japan
Phone: +81-743-72-5087 / Fax: +81-743-72-6244
E-Mail: naist-mext@ad.naist.jp

受入内諾書発行依頼書 Request form for “Letter of Acceptance”

Please fill out and submit this along with the other documents by email or registered mail.
本シートに記入し、他の必要書類一式と一緒にメールまたは郵便で提出してください。

氏名 Name in Alphabet 姓/Family Name 名/First Name, Middle Name

(as printed on your passport)

国籍 Nationality

メールアドレス Email address

内諾書送付先 Address:
The postal address for us to Postal code:
send the letter Phone:
内 諾 書 提 出 期 限 Submission
( )/( ) / 2018
deadline set by the Japanese
day / month / year
Embassy/Consulate

Please mark “X” in the boxes.

1. 希望する研究分野 Study field you would like to study at:
[ ] Information Science >> website
[ ] Biological Science >> website
[ ] Materials Science >> website
2. 希望する指導教員 Professor you would wish to have as a supervisor.
希望する指導教授がいる場合は 2 名まで記入してください。
Please list up to two professors names you wish to have as a supervisor at NAIST (if any).
第一希望/ First choice:

第二希望/ Second choice:

3. 学位取得の予定/ Which degree do you plan to obtain at NAIST?

[ ] 修士課程 / Master’s degree
[ ] 博士課程 / Ph.D.
[ ] 修士課程修了後、博士課程修了まで / Ph.D. after obtaining master’s degree of NAIST.
4. 来日希望時期/ Desired date of arrival
[ ] 春学期/ Spring semester (April)
[ ] 秋学期/ Autumn semester (October)
5. 日本語予備教育/ Would you like to participate an intensive Japanese course?
希望者は、NAIST 入学前に６か月間の日本語教育を受講することができます（任意）。
MEXT scholars can take a 6 month Japanese Language Program before starting studies at NAIST.
*This program is not mandatory and offered only to those choosing to participate.
[ ] 希望する / Yes. [ ] 希望しない / No. [ ] わからない / I haven't decided.
■ご注意： 大使館に提出した国費奨学金申請書の情報と異なる場合、本シートの情報を優先に受入審査を行います。
[Note] We will process your application based on this sheet if the information is different from the application forms for the MEXT
scholarship, which you submitted to the embassy.