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