【大学院】受験辞退届・検定料返金申請／ Exam Withdrawal Form for graduate

出願ID　 Application ID Required

Number of characters 6 Current number of characters 0

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名前　Name Required

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名前（フリガナ）　Name in katakana Optional

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メールアドレス　Mail Address Required

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出願課程　Application Program Required

修士　Master

博士　Doctor

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入試区分 Type of Exam Required

秋入学一般入試　SSFS for FALL Enrollment

春入学一般一次入試／社会人特別入試　SSFS or WA for SPRING Enrollment(1st Round)

春入学一般二次入試／社会人特別入試　SSFS or WA for SPRING Enrollment(2nd Round)

Other

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入試区分 Type of Exam Required

秋期入学一般入試　FALL Enrollment

春期入学一般入試　SPRING Enrollment

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専攻　Course Name Required

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指導(担当／研究協力）教員名　Supervisor (In-charge）Lecturer name Required

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検定料返還請求をしますか。Do you request for the refund? Required

検定料をクレジットカードで支払った方は支払元のクレジットカードに返金致します。We will refund the examination fee to the credit card used for payment.

クレジットカードで支払った検定料返還請求をする Yes, I request refund of Admission Application Fee paid by credit card.

コンビニ支払いで支払った検定料返還請求をする Yes, I request refund of Admission Application Fee paid by convinience payment.

返還請求をしない No, I do not.

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検定料返還対象事由 Reasons for requesting the admission application fee refund Required

入学検定料を納入したが、出願書類を提出しなかった　 I have paid the application fee but has not submitted the application document.

入学検定料を納入し、出願書類を提出したが受理されなかった　If the application fee was paid and the application documents were submitted but not being accepted.

入学検定料を誤って二重もしくは過剰に納入した　If there is case of double or excessive payment of the application fee by mistake.

奨学金受給者　Scholarship recipient

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奨学金名　Name of scholarship Optional

奨学金採用者はこちらに奨学金の名前を記入してください。
If you are requesting refund by other reasons from above, please fill it here.
Please write scholarship name if you are scholarship recipient.

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検定料返還対象事由 Reasons for requesting the admission application fee refund Required

入学検定料を納入したが、出願書類を提出しなかった　 I have paid the application fee but has not submitted the application document.

入学検定料を納入し、出願書類を提出したが受理されなかった　If the application fee was paid and the application documents were submitted but not being accepted.

入学検定料を誤って二重もしくは過剰に納入した　If there is case of double or excessive payment of the application fee by mistake.

奨学金受給者　Scholarship recipient

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奨学金名　Name of scholarship Optional

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返還先金融機関 Financial Institution for refund desitination Required

ゆうちょ以外（銀行・信用金庫）financial institutions other than Japan Post Bank

ゆうちょ Japan Post Bank

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金融機関コード　Bank/Institution Code Required

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金融機関名 Bank/Institution Name Required

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支店番号 Branch No. Required

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支店名 Branch Name Required

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預金種目　Deposit Type Required

普通 Savings Account

当座 Current Account

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Account Number口座番号 Required

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記号 Code Required

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口座名義 Account Holder's Name Required

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口座名義（フリガナ）Account Holder's Name in katakana Optional

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口座番号がわかる資料のアップロード Upload a file showing the account information Required

必ず下記資料を一つにしてアップロードしてください。
・口座番号が分かる資料
・振り込んだことが分かる資料

Please upload following documents in one file.
・Copy of a bankbook or cash card showing the account information
・Copy of the bank transfer receipt or email confirming your payment.

File size is 100 MB or less.

Upload File

【大学院】受験辞退届・検定料返金申請／ Exam Withdrawal Form for graduate school・Withdrawal Request