research scholarship form

8/2/2019 Research Scholarship Form

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APPLICATION FOR JAPANESE GOVERNMENT (MONBUKAGAKUSHO:M ) SCHOLARSHIP

Research Students for 2013

The application should be typed if possible, or neatly handwritten in block letters. )

Numbers should be in Arabic numerals.)

Years should be written using the Anno Domini system. )

Proper nouns should be written in full and not abbreviated. )

* Personal data entered in this application will only be used for scholarship selection purposes, and contact information such

as e-mail addresses will only be used for forming related human networks after the student returns home and for sending

information by the Japanese Government.

(E-mail

(Sex)

Name in full in your native language Male

)) (Family name/Surname) (First name) (Middle name) Female

In Roman block capitals (Marital Status)

(Family name/Surname) (First name) (Middle name) Single

Married()

Nationality 2-2Japanese nationality Yes

No

Date of birth(

19

Year Month Day Age (as of April 1,2012) 2012

Present status with the name of the university attending or employer

Present address and telephone number, facsimile number, E-mail address

E-mail

Present address

Telephone/facsimile number/FAX

E-mail address

* If possible, write an e-mail address where you can be contacted for periods that include the time before you come to Japan, your stay

in Japan and the period after you return home.

E-mail

Field of specialization studied in the pastBe as detailed and specific as possible.)

Paste a passport sized

photograph taken within

the past 6 months. Write

your name and

nationality in block

letters on the back of

the photo.

4.5cm3.5cm photo

((4.5cm3.5cm))


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Educational background

Name and Address of School

Year and Month

of Entrance and

Completion

()

Amount of time

spent at the

school attended

Diploma or Degree awarded,

Major subject

Elementary Education

()

Elementary School

Name()

Location()

From

To

years

andmonths

Secondary Education

Lower Secondary School

Name()

Location()

From

To

years

andmonths

Upper Secondary School

Name()

Location()

From

To

years

andmonths

Higher Education

Undergraduate Level

Name()

Location()

From

To

years

andmonths

*-1

Graduate Level

Name()

Location()

From

To

years

andmonths

Total years of schooling mentioned above

As of April 1,2012

(2012)

Years and months

* If the blank spaces above are not sufficient for the information required, please attach a separate sheet

(() )

Notes: Exclude kindergarten education or nursery school education. ()

Include preparatory education for university admission in secondary education.

If the applicant has passed the university entrance qualification examination, indicate this in the blank with *-1.(

-1)


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State the titles or subjects of books or papers (including graduation thesis authored by the applicant), if any, with the name and address

of the publisher and the date of publication.

Please write the title of your graduation thesis or project paper.

* Please attach abstracts of those papers to this application.

()

Employment record: Begin with the most recent employment excluding the part-time job.

Name and address of organization

Period of employment

Position

Type of work

From

To

From

To

10Japanese language proficiency: Evaluate your level and insert an X where appropriate in the following blank space.

Excellent

Good

Fair

Poor

Reading

Writing

Speaking

11Foreign language proficiency: Evaluate your level and insert an X where appropriate in the following blank space.

Excellent

Good

Fair

Poor

English

French

German

Spanish

12The first course you plan to take in Japan

Please mark either ), ), ) or ) with a circle.

) Research student

) Master's degree course

) Doctoral course

) Professional graduate course


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13Proposed period of study


) I wish to arrive in Japan in April.

) Although I wish to arrive in Japan in April, October is possible.10

) Although I wish to arrive in Japan in October, April is possible.10

) I wish to arrive in Japan in October.10

14Term you wish to study in Japan


* Please refer to item 3 titled Term of Scholarship in the document titled Japanese Government Scholarship for 2012 for more

information on the term of scholarship and the conditions for extending the term.

) Only a research students term (two years or one year and six months)

) From a research student through masters degree course completion

) From a research student through doctoral course completion

) From a research student through professional graduate course completion

15Have you been awarded a Japanese Government (Monbukagakusho) Scholarship in the past? If so, please specify the period, the name of

the university, etc.

) Yes, I have.

Period: University:

) No, I have not.

16. Accompanying Dependents; (Provide the following information if you plan to bring any family members to Japan.)

* All expenses incurred by the presence of dependents must be borne by the grantee. He/She is advised to take into consideration various

difficulties and the great expense that will be involved in finding living quarters. Therefore, those who wish to be accompanied by

their families are advised to come alone first and let their dependents come after suitable accommodation has been found.

Name

Relationship

( )

Age

17. Person to be notified in applicant's home country in case of emergency:

()

Name in full:

Address: with telephone number, facsimile number, e-mail address

E-mail

Present address

Telephone/Facsimile number/FAX

E-mail address

( )


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Occupation:

Relationship:

18. Immigration Records to JapanBegin with the most recent travel to Japan

Date Purpose

From

To

From

To

19. Do you have Japanese Nationality?

) Yes, I have.

) No, I have not.

)

20. Do you have Permanent Resident Visa of Japan?

) Yes, I have.

) No, I have not.

)

Note: If selected for the scholarship the candidate will have to cancel all other types of visas of Japan and will have to apply only for

student visa.

I understand and accept all the matters stated in the Application for Japanese Government (MONBUKAGAKUSHO:MEXT) Scholarship for 2013,

and hereby apply for this scholarship

2013

Date of application:

Applicant's signature:

Applicant's name

in Roman block capitals

research scholarship form

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