東北大学 令和4年度(2022年度)特別選抜入学試験学生募集要項 グローバル入試II期(理学部・工学部)
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Please do not mark in the above space. Please print this as a double-sided form. Tohoku University Admissions for Global Entrance Examination Ⅱ Applicant Assessment Form (Please ask your high school etc. to prepare this form.) Date____________________________ TO President of Tohoku University School Name ____________________________ Principal's Name ____________________________ Official Seal Form Preparer ____________________________ Seal Address ____________________________ Phone No. ____________________________ I take responsibility for its evaluation of the below-named applicant for a Global Entrance ExaminationⅡ. 1. Applicant's Name etc. Phonetic Japanese (if known) Gender (M/F) Date of Birth (D/M/Y) Date/Expected Date of Graduation/Completion: / / Name / / 2. Desired School/Faculty etc. Desired School/Faculty Department/ Course School/Faculty of: Science Department of: Department of Chemistry Advanced Molecular Chemistry Course 3. Comments Faculty of Science

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