[ICU] CoE Application Form

[ICU] Certificate of Eligibility (CoE) Online Application Form

[Deadline] March 14, 2025, JST
All non-Japanese applicants for the Exchange/Invitee Program must complete this form for a Certificate of Eligibility, which is necessary for applying for a student visa.

Before working on this form, please be sure that you have all the following required documents.

1. [ICU-C] Declared Items for Certificate of Eligibility Surety Pledge
2. [ICU-D] Supporter Pledge for Certificate of Eligibility
3. Financial supporting documents
4. Coloured Identical photo 

Note: The maximum size of the upload files is 10MB in total.

Please write your answers all in CAPITAL LETTERS.

CoE Application Part 1.
1. Personal Information
Name (FAMILY, GIVEN MIDDLE)
(e.g) SAMPLE, EMILY
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)
(e.g.) 2003/04/15
Gender on Your Passport
Marital Status
Email Address
*Email address does not have to be written in capital letters.
2. Passport Information
Do you hold a valid passport?
Please write the information about the passport you intend to use when you enter Japan.

*IMPORATNT: 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.
Nationality
The list only includes the countries where we have our partner universities. If your country is not listed, please choose "OTHERS".
Please write the name of the country of your passport.
(e.g.) ITALY
Passport Number
For those who do not hold a valid passport when you are filling this out, please write "NA".
Date of Expiration (YYYY/MM/DD)
(e.g.) 2026/01/15
For those who do not hold a valid passport when you are filling this out, please write "NA".
Place of Birth (CITY/STATE, and COUNTRY)
(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, please write the CITY (PREFECTURE), PROVINCE and COUNTRY.
　(e.g.) SHENYANG, LIAONING, CHINA
Home Town (CITY, STATE, and COUNTRY)
(e.g.) LOS ANGELES, CA, 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, 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?
→If you answered "Yes" above (you have more than one valid passport), please specify the name of the country(ies) of passport(s).
3. Japan Entry Information
Place to Apply for a Student Visa (CITY/STATE, and COUNTRY)
(e.g.) LOS ANGELES, USA
・Please insert ", " (a comma and a space) between the city or state and country.
・You can check the locations of the Japanese Embassy/Consulate closest to your home; http://www.mofa.go.jp/about/emb_cons/over/index.html.
Expected Date of Entry into Japan (YYYY/MM/DD)
(e.g.) 2024/08/25
Tentative Port of Entry
If you answered "OTHER" above, please specify the Port of Entry.
Accompanying Persons (who will come to Japan with you)
→If you answered "YES" above (you have a dependent), please specify the relationship of the dependent(s) to the applicant.
Have you ever visited Japan? (Transit is not counted.)
How many times?
time(s)
If never, please fill in "0".
→Period of your latest entry into Japan (YYYY/MM/DD)
from (e.g.) 2019/07/30
→Period of your latest entry into Japan (YYYY/MM/DD)
to (e.g.) 2019/08/15
Have you ever applied for a certificate of eligibility (CoE)?
→How many times have you applied?
time(s)
→How many times the CoE was NOT issued among these applications?
time(s)
Do you have any criminal Record in Japan or Overseas?
→If you answered "YES" above (you have a criminal record), please write the details.
Have you ever departed Japan by deportation or departure order?
→How many times?
time(s)
If never, please fill in "0".
→The latest departure by deportation (YYYY/MM/DD)
(e.g.) 2018/08/15
4. Education
Total Period of Education (years)
Cumulative years of education since elementary school enrollment
Current Status
Name of School
Name of Home Institution_OTHERS
For those who are applying through consortium/alliance, please write your home university.
Name of Home Institution_ACUCA
For those who are applying through consortium/alliance, please write your home university.
Name of Home Institution_JCCI
For those who are applying through JCCI, please write your home university.
Degree (Expected)
Date of Entrance (YYYY/MM)
Expected Graduation (YYYY/MM)
5. Family* or co-residents in Japan

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.
Name of your family or co-resident(s) in Japan (FAMILY, GIVEN MIDDLE)
(e.g.) SAMPLE, JOSEPH ICU
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.
Relationship to Applicant
Nationality
Date of Birth (YYYY/MM/DD)
(e.g.) 1975/03/15
Name of Company, School, etc.
Intend to reside with the applicant?
Status of Residence*
*(e.g.) Japanese National, Non-Japanese Permanent Resident, Diplomat, Official, Professor, Artist, Religious Activities, Journalist, Investor/Business Manager, Legal/Accounting Services, Intra-company Transferee, Entertainer, Skilled Labor, Cultural Activities, Student, Trainee, Dependent, Designated Activities, Spouse or Child of Japanese National, Spouse or Child of Permanent Resident, and Long Term Resident.
Residence Card Number / Special Permanent Resident Certificate Number
CoE Application Part 2.
In order for us to apply for your Certificate of Eligibility (CoE) to the Immigration Services Agency, we are responsible to make sure you have sufficient funds set aside to use as your living expenses during your program.
This should NOT include tuition and fees for your home institution.

The total amount must exceed JPY 100,000 per month, and can be provided by multiple resources.
The scanned copy of original documentation verifying the funds claimed (i.e. official certification of account balance, official letter of award) must be attached to this form.
The original documentation must be couriered/mailed to arrive ICU International Office by October 31.
1. Financial Support
Length of your stay at ICU
Methods of support
Please check all the financial supporters during your stay in Japan.
Financial aid from your university is categorized as Loan, Scholarship, or Others.
An amount of support from Yourself PER MONTH (average)
Youself: JPY per month
Please write the amount of support from yourself per month in Japanese yen. (e.g.) 100,000
An amount of support from Your Family PER MONTH (average)
Family: JPY per month
Please write the amount of support from your family per month in Japanese yen. (e.g.) 100,000
An amount of support from Loan PER MONTH (average)
Loan: JPY per month
Please write the amount of support from loan per month in Japanese yen. (e.g.) 100,000
An amount of support from Scholarship PER MONTH (average)
Scholarship: 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
Total JPY per month
Please write the total amount of support per month written above in Japanese yen. (e.g.) 100,000
2. Supporter's Detail
Who is your MAIN supporter?
Relationship of the main supporter to the applicant
・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)".
If you select "Others" above, please specify the relationship to the applicant.
Supporter's Official Name
(e.g.) SAMPLE, ERIC ICU
Supporter's Occupation
Supporter's Deposit Balance
(i.e.) JPY 5,000,000
Please write with the currency.
*This amount must be consistent with the attached scanned copy financial supporting documents.
Supporter's Name of Company, School, etc.
Name and Title of Agency Official
Name of Agency
Address
Phone Number (Home)
(e.g.) (81) 222-333-444
Please write the country code in the parenthesis and do not write "+" before the country code.
Phone Number (Office)
(e.g.) (81) 222-333-444
Please write the country code in the parenthesis and do not write "+" before the country code.
[ICU-C] Declared Items for Certificate of Eligibility Surety Pledge
Please attach a copy of the form by clicking the button.

＊Original Form must be couriered (mailed) to ICU International Office to be arrived by March 31.

＊Please make sure to sign in handwriting with a ballpoint pen.
[ICU-D] Supporter Pledge for Certificate of Eligibility
Please attach a copy of the form by clicking the button.

＊Original Form must be couriered (mailed) to ICU International Office to be arrived by March 31.

＊Please make sure to sign in handwriting with a ballpoint pen.
The scanned copy of original financial supporting documents
Please attach a copy of financial documentation (i.e. official certification of account balance, official letter of award) by clicking the button.
You can combine multiple resources, but you must attach all the documentation.

＊Original Form must be couriered (mailed) to ICU International Office to be arrived by March 31.

＊Please make sure to sign in handwriting with a ballpoint pen.
Coloured Identical Photo
PLEASE CHECK BEFORE YOU SUBMIT
・Have you changed the file name to "Photo_University name_NAME"?
(e.g.) Photo_ICU_Noriko Kimura
・Please refer to the photo format specifications.

Confirmation
I hereby declare that the statements provided above are true and correct, and I consent to the disclosure of the information given here to the Immigration Services Agency through the proxy, International Christian University, for my application for Certificate of Eligibility. I also understand that any questions I answered incorrectly can result in the cancellation of my application, if discovered later, in my dismissal from the university.