A P P L I C AT I O N F O R J A PA N E S E G O V E R N M E N T

MONBUKAGAKUSHO:MEXT) SCHOLARSHIP

College of Technology Students for 2013

INSTRUCTIONS
The application should be typed if possible, or neatly handwritten in block letters. )
Numbers should be in Arabic numerals. )
Year 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

Name in full, in your native language

(Sex)

Male

(Family name/Surname)

(First name)

Female

(Middle name)

In Roman capital letters

(Marital Status)

(Family name/Surname) ,
(First name)
(Middle name)
(Please write your name exactly as it appears in your passport.)

Married( )

Single

-1 Nationality -2Possession of Japanese nationality Yes, I have

No, I dont have

Paste your photograph

or digital image taken
within the past 6
months. Write your
name and nationality in

Date of birth(

block letters on the

back of the photo.

19 Age
Year

Month

Day as of April 1,2013(2013

4.5 x 3.5 cm photo

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

((4.5cm3.5cm))

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
Chosen field of study and Majors and related key terms in Japan
Select from Majors and Related Key Terms for Fields of Study

Field of Study Majors and Related Key

Terms
First choice

( )

 Second choice

Third choice

Field of study you specialized in at high school or university

Present status (with name of school attending or employer)

StudentName of school
( )
in
grade / will graduate in

Year

Month

Those in employment Name of employer

Educational background:
Name and Address of School

Year and Month

of Entrance and
Completion

Duration of
Attendances

Diploma or Degree awarded,

Major Subject, Skipped
years/levels

Name
)

From
y
ears

Location
Name
)

To
From

Upper Secondary School

Location
Name
)

To
From

and
y
ears

Higher Education

Location
Name
)

To
From

and
y *
ears

Elementary Education
( )
Elementary School

Secondary Education

Lower Secondary School

Undergraduate Level

Location
To
Total of the years schooling mentioned above

As of April 1, 2013
(2013 4 1 )

and
y

ears

and
y
ears
and

months

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

Preparatory education for university admission is included in upper secondary school.
)
The applicant who has more than one major at his/her university should list all majors in the blank space with *
*
Any school years or levels skipped should be indicated in the fourth column(Diploma or Degree awarded, Major Subject,
Skipped years and levels).(Example: Graduated high school in two years, etc.)

3
Language proficiency:
(1) Evaluate your ability as Excellent", Good", or Poor" in the blank space.

Reading

Writing

Speaking

Japanese

English

Others(
( )

10. Japanese language background, if any. ( )

) Name and address of institution

( )

) Period of study

( )

from to
Year( )

Month( )

Year( )

Month( )

Years( )

11 Majors and reasons

Reasons for choosing to majors and related key terms entered in section 5. N.B. Specify reasons for each Major and related key
terms entered in section 5. Also, ensure that the majors in this section are the same as the Majors and Related Key Terms
entered in section 5.
( )

First choice

Second choice

Third choice

12 What kind of field are you planning to study in Japan?

( )

13. What kind of impression do you have of Japan?

14 Description of desired employment to be taken up after returning home.

( )

15. 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

Occupation:

Relationship with the applicant:

name(s) of family member(s):

Father( ) Occupation( ) Nationality( )

Mother( ) Occupation( ) Nationality( )

16.Immigration Records to Japan Begin with the most recent travel to Japan
Date

Purpose

From
To
From
To

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 letters capitals