Toho Univeristy Clinical Training Application Form

Clinical Training Application Form
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 Email
Date of Birth*

YearMonthDay
Age*
Nationality*
Institution currently working*
Medical school conferred a medical degree*
Total length of medical course*

4 years5 years6 yearsOther
Date of graduation*

YearMonthDay
Clinical medical training or experiences 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
Starting date*

YearMonthDay
Last date*

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
Date of medical license issued*

DayMonthYear
Is your mother tongue English?*

YesNo
Have you acquired a degree in a program where Japanese or English was the primary language of instruction*

YesNo
The following documents have to be submitted when you submit this application form. Please convert documents and images to PDF except your face photo. Please also note that the maximum size per file should not exceed 1.1 MBytes.
Letter of Recommendation from Hospital*

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Required Supporting Documentaion*

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On a form specified by TOHO Cancelof
Immunization Record*

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On a form specified by TOHO Cancelof
Assessment of chest X-ray

Upload a File

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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
Copy of Medical License*

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If not in English, an English translation must be attached. Cancelof
Short CV*

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Please include your work experience as well as areas of research you have involved Cancelof
Proof of Immunization against COVID-19*

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Three dots required Cancelof
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