Toho University ECC Application Form-MOU

Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*

Confirmation Emailexample@example.com
Date of Birth*

YearMonthDay
Age*
Nationality*
Medical school currently enrolled*
Medical school currently enrolled*
Total length of medical course*

4 years5 years6 yearsOther
Expect date of graduation*

YearMonthDay
Clinical medical education completed prior to clinical clerkship at Toho University*
Preferred elective topics (First choice)*
Preferred elective topics (Second choice)*
Preferred elective topics (Third choice)*
Gender*

MaleFemale
NO ELECTIVE PROGRAMS ON FOLLOWING HOLIDAYS (AY2024-2025)

April 1-5, April 29, May3-6, July 15, August 12, September 16, September 23, October 14, November 4, December 23-January 5, 2025, January 13, February 11, February 24, March 20
Start date (Not date of arrival)*

YearMonthDay
Last date (Not date of departure)*

YearMonthDay
Total number of weeks*

2 weeks3 weeks4 weeks5 weeks6 weeks7 weeks8 weeksOther
Do you want to stay in University Housing?*

YesNo
Do you need an invitation letter from Toho University Faculty of Medicine for your visa?*

YesNo
Is your mother tongue English?*

YesNo
Is the primary language of instruction in the MD program you have enrolled either English or Japanese ?*

YesNo
The following documents have to be submitted when you submit this application form. Please convert documents and images to PDF, except for a face photo. Please also note that the maximum size per file should not exceed 1.1 MBytes.
Medical School Dean Applicant Evaluation*

Upload a File

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Required Supporting Documentaion *

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Immunization Record*

Upload a File

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Assessment of chest X-ray

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Image of chest X-ray

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Copy of passport*

Upload a File

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Proof of English proficiency*

Upload a File
Only scores of TOEFL, IELTS, or CEFR accepted. Cancelof
Face photo *

Upload a File
Taken within 6 months of application dateNo hat (*except for religious reasons)No backgroundFace should be in front of the applicantClear image quality Cancelof
Proof of immunization against COVID-19 *

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Three doses required Cancelof
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