[ICU] Certificate of Eligibility (CoE) Online Application Form（在留資格認定証明書CoEオンライン申請）

All Non-Japanese Accepted Applicants must complete this form for a Certificate of Eligibility, which is necessary in applying for a student visa.
日本国籍を保有しない合格者は、学生ビザを取得するために必要な在留資格証明書申請（CoE）が必要です。

Prepare the following documents prior to the form submission.
申請情報を入力する前に以下の書類をご準備ください。

1. Referential Document for Financial Resources（資金源根拠資料）
2. Declared Items for Certificate of Eligibility Surety Pledge（CoEオンライン申請の誓約書）
3. Supporter's Pledge（経費支弁者誓約書）
4. Copy of your passport（パスポートコピー）
5. Photo（顔写真）

Note: The maximum size of the upload files is 8MB in total.
添付ファイルは8MBまででお願いします。

Please write all your answers in CAPITAL LETTERS.　
回答は全てローマ字大文字で記入してください。

CoE Application Part 1.


1. Personal Information（個人情報）
Application Number　（受験番号）
(e.g.) E9000
Name (FAMILY, GIVEN MIDDLE)　（氏名）
(e.g) SAMPLE, EMILY ICU
Please write your name in CAPITAL LETTERS as it appears on your passport.
Please insert ", " (a comma and a space) after your family name.
Date of Birth (YYYY/MM/DD)　（生年月日）
(e.g.) 19XX/01/15
Sex on Your Passport　（パスポートに記載の性別）
Marital Status　（配偶者の有無）
Your Current Phone Number　（電話番号）
+
(e.g.) (81)222-333-444
Please write the country code in the parentheses and do not write "+" before the country code.
Email Address (メールアドレス)
* Email address does not have to be written in capital letters


2. Passport Information（パスポート情報）
Do you hold a valid passport?　（現在有効なパスポートを所有していますか。）
Please write the information about the passport you intend to use when you enter Japan.

*IMPORTANT: Students who hold Japanese nationality, including those who currently do not possess a Japanese passport but have eligibility for applying for it, must enter Japan with a Japanese passport.　日本国籍を所有している合格者（現在日本のパスポートを所有していなくても所有資格を保持している者を含む）は、日本のパスポートで入国しなければいけません。
Nationality　（国籍）
If your nationality is Taiwan or Hong Kong, please write as TAIWAN or CHINA (HONG KONG) respectively.
Passport Number　（旅券番号）
For those who do not hold a valid passport when you are filling this out, please write "NA", and contact the Educational Affairs Group (ent-procedure@icu.ac.jp)
Date of Expiration (YYYY/MM/DD)　（有効期限）
(e.g.) 2029/01/15
Place of Birth (CITY/STATE, and COUNTRY)　（出生地）
(e.g.) CALIFORNIA, USA
・Please write the name of city or state and country in CAPITAL LETTERS as it appears on your passport.
・Please insert " , " (a comma and a space) between the city or state and country.
・If your Place of Birth is in China or Vietnam, please write the CITY (PREFECTURE), PROVINCE and COUNTRY.
(e.g.) SHENYANG, LIAONING, CHINA
Home Town (CITY, STATE, and COUNTRY)　（本国における居住地）
・Please write the name of city or state and country in CAPITAL LETTERS as it appears on your passport.
・Please insert ", " (a comma and a space) between the city, state and country.
・If you do not have the address in the country of your passport, please fill in the name of city, state and country where you currently live in.
・If your Home Town is in China, please write the CITY (PREFECTURE), PROVINCE and COUNTRY
　(e.g.) SHENYANG, LIAONING, CHINA.
Do you hold more than one valid passport?　（複数の有効なパスポートを所有していますか。）
→If you answered "YES" above (you have more than one valid passport), please specify the name of the country(ies) of passport(s).　（複数の有効なパスポートの国名を記入してください。）


3. Japan Entry Information（日本入国時情報）
Place to Apply for a Student Visa (CITY/STATE, and COUNTRY)　（査証申請予定地）
(e.g.) LOS ANGELES, USA

Write a location (city AND country) of the Japanese Embassy or Consulate where you are going to apply for your visa. The place can be tentative.
・Please insert " , " (a comma and a space) between the city or state and country.
・You can check the locations of Japanese Embassy/Consulate closest to your home:
https://www.mofa.go.jp/about/emb.cons/over/index.html .
未定の場合、自宅から一番近い日本大使館、領事館を記入してください。
Expected Date of Entry into Japan (YYYY/MM/DD)　（入国予定年月日）
(e.g.) 2024/08/29
Tentative Port of Entry　（上陸予定空港）
If you answered "OTHER" above, please specify the Port of Entry.　（その他の場合、どこの空港ですか。）
Will you have accompanying person(s)?　（同伴者の有無）
→If you answered "YES" above, please specify the relationship of the person(s) to the applicant.　（YESの場合、合格者との続柄）
Have you ever visited Japan? (Transit does not count.)　（過去日本に来たことありますか。乗り継ぎは含みません。）
How many times?　（回数）
time(s)
If never, please write "0".
→ Date of your Latest Entry into Japan (YYYY/MM/DD)　（直近の入国歴）
from (e.g.) 2015/07/30
→ Date of your Latest Departure from Japan (YYYY/MM/DD) （直近の出国歴）
to (e.g.) 2015/08/15
Do you have any criminal record in Japan or Overseas?　（犯罪を理由とする処分を受けたことの有無（日本国外におけるものも含む））
→If you answered "YES" above (you have a criminal record), please write the details.　（YESの場合、具体的内容）
Have you ever departed Japan by deportation or departure order?　（日本からの退去強制又は出国命令による出国の有無）
→How many times?　（回数）
time(s)
If never, please write "0".
→The Latest Departure by Deportation (YYYY/MM/DD)　（直近の送還歴）
(e.g.) 2015/05/20
Have you ever applied for a certificate of eligibility (CoE)? (過去に在留資格認定書（CoE）を申請したことはありますか？）
→How many times have you applied? (何回申請しましたか。）
time(s)
→How many times the CoE was NOT issued among these applications? (申請したうち、不交付だった回数は何回ですか。）
time(s)


4. Education（学歴）
Total Period of Education (years)　（合計修学年数）
Write your cumulative years of education from elementary school (Grade 1) to the latest educational institution, including this year, if you are currently enrolled at an educational institution.
If you are enrolled at any educational institution in Japan at the time of application, write your cumulative years of education and name of school in your home country.
小学校から現在までの合計修学年数
Total Period of Education (years)　（20年以上である場合、何年ですか。）
Please write the number of years.
Current Status　（現在の在籍状況）
Degree or Diploma(Expected)　（学位（見込み））
Name of School prior to the enrollment to ICU　（ICU入学前の学校名）
Date of Entrance (YYYY/MM/DD)（入学日）
(e.g.) 2020/4/1
Date of Graduation or Expected Date of Graduation (YYYY/MM/DD)　（卒業日または卒業見込み日）
(e.g.) 2024/3/31



5. Family* or co-residents in Japan　（在日親族（父、母、配偶者、子、兄弟姉妹など）及び同居者）


If you have a family or co-resident(s) in Japan, please answer all the questions.
If not applicable, please proceed to "CoE Application Part 2".

Family: father, mother, spouse, child, brother, sister, etc.

該当しなければ、”CoE Application Part 2"へ進んでください。
Name of your family or co-resident(s) in Japan (FAMILY, GIVEN MIDDLE)　（在日親族、同居者の氏名）
(e.g.) SAMPLE, JOSEPH ICU
If you have a family in relation of the first or the second degree, provide information as accurately as possible.
If no, write None.
Please write your family/co-resident's name in CAPITAL LETTERS as it appears on his/her passport.
Please insert ", " (a comma and a space) after his/her family name. If the person is Japanese, please also give the name in kanji character.
Relationship to Applicant　（志願者との続柄）
Nationality　（国籍）
Date of Birth (YYYY/MM/DD)　（生年月日）
(e.g.) 1990/03/15
Name of Company, School, etc.　（勤務先、通学先）
Does he/she intend to reside with the applicant?　（同居予定）
Status of Residence*　（在留資格）
* (e.g.) Japanese National, Non-Japanese Permanent Resident, Diplomat, Official, Professor, Artist, Religious Activities, Journalist, Investor/Business Manager, Legal/Accounting Services, Medical Services, Researcher, Instructor, Engineer, Specialist in Humanities/International Services, Intra-company Transferee, Entertainer, Skilled Labor, Cultural Activities, Student, Trainee, Dependent, Designated Activities, Spouse or Child or Japanese National, Spouse or Child of Permanent Resident, Long Term Resident.
すなわち、日本国籍、外国人永住者、外交、公用、教授、芸術、報道、経営/管理、法律/会計業務、医療、研究、教育、技術/人文知識/国際業務、企業内転勤、興行、技能、文化活動、留学、研修、家族滞在、特定活動、日本人の配偶者等、永住者の配偶者等、定住者
Residence Card Number / Special Permanent Resident Certificate Number　（在留カード番号/特別永住者証明書番号）


CoE Application Part 2.
In order for us to apply for your Certificate of Eligibility (CoE) to the Immigration Bureau, we are responsible to make sure you have sufficient funds set aside as your living expenses, excluding tuition/facilities fee.

The minimum amount is JPY100,000 per month, in other words, the total amount of the balance must exceed JPY1,200,000 (JPY100,000 x 12 months). This can be provided from multiple resources.
The scanned copy of original documentation verifying the funds claimed (e.g. an official certification of account balance, an official letter of award, an official letter of financial guarantee) must be attached to this form.
The original documentation must be couriered to arrive ICU Entrance Procedures by the deadline specified in the ENTRANCE PROCEDURES GUIDE.

留学ビザを申請する学生は、在学中に必要となる全ての支出をカバーする充分な資金があることを日本政府に対し書面で証明する必要があります。具体的には在学中に生活費（最低10万円/月額、最低120万円/年）を賄う能力があるかを証明することです。
複数の資金源でも可能です。その場合、全ての根拠書類を提出して下さい。スキャンした書類をこのフォームに添付し、原本は他の入学手続き書類と一緒に期日までに郵送してください。


1. Financial Support（経費支弁）
Methods of Support　（支弁方法）
Please check all the financial supporters during your stay in Japan.
全ての支弁者にチェックを入れてください。
Amount of support from "Yourself" PER MONTH (average)　（自分自身の場合、月平均経費支弁額）
JPY per month
Please write the amount of support from yourself per month in Japanese yen.
(e.g.) 100,000
Amount of support from "Family" PER MONTH (average)　（家族の場合、月平均経費支弁額）
JPY per month
Please write the amount of support from your family per month in Japanese yen.
(e.g.) 100,000
Amount of support from "Loan" PER MONTH (average)　（ローンの場合、月平均経費支弁額）
JPY per month
Please write the amount of support from loan per month in Japanese yen.
(e.g.) 100,000
Amount of support from "Scholarship" PER MONTH (average)　（奨学金の場合、月平均経費支弁額）
JPY per month
Please write the amount of support from scholarship per month in Japanese yen.
(e.g.) 100,000
Total amount of support PER MONTH in JPY　（合計）
Total: JPY per month
Please write the total amount of support per month written above in Japanese yen.
(e.g.) 100,000
通貨は日本円で記入してください。



2. Supporter's Detail（経費支弁者詳細）
Who is your MAIN supporter?　（主な支弁者）
Relationship of the main supporter to the applicant　（続柄）
・For those who chose "A) Yourself or Family", please choose one with "A)".
・For those who chose "B) Loan or Scholarship", please choose one with "B)".
Supporter's Official Name (FAMILY, GIVEN MIDDLE)　（支弁者の氏名）
(e.g.) SAMPLE, ERIC ICU
Home Address of the Supporter　（支弁者住所）
(e.g.) xxxAve., LOS ANGELES, CA 90036 USA
Phone Number (Home)　（電話番号（自宅））
+
(e.g.) (81)222-333-444
Please write the country code in the parentheses.
Supporter's Occupation　（職業）
Please write "RETIRED" if so.
Supporter's Name of Company, School, etc.　（勤務先・通学先）
Write the name of company, shop, etc., even if your supporter is self-employed or owns a family business.
Please write "RETIRED" if so.
経費支弁者が自営業や同族会社所有者でも企業名を記入すること。定年退職した場合は”RETIRED"と記入してください。
Phone Number (Office) （電話番号（職場））
+
(e.g.) (81)222-333-444
Please write the country code in the parentheses.
Supporter's Deposit Balance　（支弁者の預金残高）
(e.g.) JPY 5,000,000
Please include the currency.
* This amount must be consistent with the attached scanned copy of the financial supporting documents.
通貨を忘れずに記入してください。
*この金額は添付する資金源根拠書類と一致すること
Name and Title of Agency Official　（経費支弁機関担当官氏名、役職）
Name of the Agency　（経費支弁機関名）
Address of the Agency　（機関住所）
Phone Number of the Agency　（電話番号（機関））
+
(e.g.) (81)222-333-444
Please write the country code in the parentheses.
1. Referential Document for Financial Resources　（資金源根拠書類）
Please attach a copy of the financial documentation(e.g. official certification of account balance, official letter of award, copy of letter of financial guarantee issued by Rotary International) by clicking the button.
You can combine multiple resources, but you must attach all the documentations.

Original documentations must be couriered to ICU Entrance Procedures by the deadline specified in the ENTRANCE PROCEDURES GUIDE.
2. Declared Items for Certificate of Eligibility Surety Pledge　（CoE情報誓約書）
Please attach a copy of the form(this can be downloaded from the ENTRANCE PROCEUDERS GUIDE) by clicking the button.

Original Form must be couriered to ICU Entrance Procedures by the deadline specified in the ENTRANCE PROCEDURES GUIDE.

参照ボタンを押して誓約書（誓約書はENTRANCE PROCEUDERS GUIDEよりダウンロードしてください。）を添付してください。
3. Supporter's Pledge　（経費支弁者誓約書）
Please attach a copy of the form(this can be downloaded from the ENTRANCE PROCEUDERS GUIDE) by clicking the button.
If a signature of the supporter appears on the referential financial resources documentations, simply write the name of the person or the agency and leave the rest blank.

Original documentations must be couriered to ICU Entrance Procedures by the deadline specified in the ENTRANCE PROCEDURES GUIDE.

参照ボタンを押して誓約書（誓約書はENTRANCE PROCEUDERS GUIDEよりダウンロードして下さい。）を添付してください。
4. Scanned copy of your Passport　（パスポートの写し）
Please attach a copy of your passport.
Please submit the pages of your passport showing your name, date of birth, place of issue, passport number, dates of issue and expiration, issuing authority and photo.
If you are in the process of applying for one, attach a copy of your old passport, or contact the Educational Affairs Group (ent-procedure@icu.ac.jp)
5. Photo　（顔写真）
- Please attach a photo of your face, facing forward. Make sure and check the link beforehand
https://www.isa.go.jp/en/applications/guide/photo_info.html
- Plain background, Nothing in the background (including shadows)
- No headgear may be worn in the photograph.
- Photo must be taken within 3 months prior to application
- The quality must be very good enough to be used to apply for a passport
Confirmation　（確認）
ファイルアップロード