Official Seal * Please print this as a double-sided form. * Please ask your high school etc. to prepare this form. For the Academic Year 2026 ATTN: President of Tohoku University School Name __________________________________ Principal's Name __________________________________ Form Preparer’s Position: School Address __________________________________ Phone No. Your school takes responsibility for its evaluation of the below-named applicant who holds an International Baccalaureate. 1. Applicant's Name, etc. 2. Desired School/Faculty, etc. 3. Confirmation of Activity reports Phonetic Japanese (if known) Name Desired School/Faculty School/Faculty of: Date/Expected Date of Graduation/Completion Gender Date of Birth Desired Division/Department (Enter only if the student desires the Faculty of Science or School of Engineering) Division/Department of: YYYY MM DD Date_______/_______/______ YYYY MM DD Please do not mark in the above space. Male / Female / / / / YYYY MM DD (place a check mark) □ I have confirmed the Activity reports (活動報告書) filled out by the applicant. Name: Signature: __________________________________ Applicant Assessment Form for IB Entrance Examination
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