application+form+for+steps
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7/31/2019 Application+Form+for+STEPs
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Application Form
for Short Term Exchange Program with Scholarship(STEPs) 2012
Shibaura Institute of Technology
Please submit this application with CV and the latest transcript to
international office at home university.
Writing signature, hand-writing, on the last page after printing is necessary.
1. FULL NAME *please provide as shown in the passport
in Roman block capitals Please click here and type textsin native language, if applicable Please click here and type texts
2. NATIONALITY Please click here and type texts
4. DATE OF BIRTH
MONTH DATE YEAR
Please choose the month Please choose the date Please choose the year
5. PASSPORT INFORMATION
Number Please click here and type texts
Date of Issue (MM/DAY/YYYY) Please choose the month Please choose the date Please choose the year
Date of Expiry (MM/DAY/YYYY) Please choose the month Please choose the date Please choose the year
6. NAME OF UNIVERSITY AND DEPARTMENT *please provide your home university.
University Please click here and type texts
Department Please click here and type texts
Present Status (Ex, 4th year of Bachelor) Please click here and type texts
7. EDUCATIONAL BACKGROUND
University (Bachelor) Please click here and type texts
Major Please click here and type texts
Completion Date (MM/DAY/YYYY) Please choose the month Please choose the date Please choose the year
University (Master) Please click here and type texts
Major Please click here and type texts
3. GENDER Please choose your gender
Paste a photograph or digital
image taken within the past 6
months.
Photo
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Completion Date (MM/DAY/YYYY) Please choose the month Please choose the date Please choose the year
University (Doctoral) Please click here and type texts
Major Please click here and type texts
Completion Date (MM/DAY/YYYY) Please choose the month Please choose the date Please choose the year
8. PRESENT (MAILING)ADDRESSPlease click here and type texts
Email address Please click here and type texts
Telephone number (home) Please click here and type texts
Telephone number (mobile) Please click here and type texts
FAX number Please click here and type texts
9. TERMS Please fill out desired month to start STEPs and duration. *Range from 32 days to 62 days
Starting from Duration
1st option Please choose your desired month/year Please choose the duration
2nd option Please choose your desired month/year Please choose the duration
3rd option Please choose your desired month/year Please choose the duration
Should you have certain requests, state it here.. Please click here and type texts
10. Research field at Home university and desired research topic during STEPs at Shibaura Institute of Technology.
Please click here and type texts
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11. Desired activities at Shibaura Institute of Technology except for Lab. activity, if any
Please click here and type texts
Please answer the following items
Date Signature
Do you want to attend Japanese lessons? Please choose your answer
Are you planning to apply HBT program in SIT? Please choose your answer
Do you request to stay at DK house warabi?IfNo, you need to arrange your accommodation. Please choose your answerIfYes for , do you prefer single room?IfNo, you will share a room with other STEPs student. Please choose your answer