APPLICATION FOR JAPANESE GOVERNMENTMONBUKAGAKUSHO:MEXT)SCHOLARSHIP

Undergraduate Students for 2014

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 (Family name/Surname) In Roman capital letters (Family name/Surname) (First name) (Middle name) (First name) (Middle name) (Sex) Male Female (Marital Status) Single Married()

(Please write your name exactly as it appears in your passport.) -1Nationality -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( 19 Year Month Day Age as of April 1, 20142014

block letters on the back of the photo. 4.5 x 3.5 cm photo ((4.5cm3.5cm))

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 Chosen field of study in Japan Select from 1.FIELDS OF STUDYin Application booklet.(i.e. Mathematics, Physics ) 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: Student Name of school () Those in employmentName of employer Educational background: Name and Address of School Elementary Education () Elementary School Secondary Education Lower Secondary School Location ) Name ) Upper Secondary School Location ) Name ) Location ) To From To and months years and months years and months *-2 To From and months years *-1 Location ) Name ) To From and months years Name ) Year and Month of Entrance and Completion From Duration of Attendances years Diploma or Degree awarded, Major Subject, Skipped years/levels

in grade

/ will graduate in

Year

Month

Higher Education Undergraduate Level

Total of the years schooling mentioned above As of April 1, 2014 (2014 4 1 )

Notes: Exclude kindergarten education or nursery school education. () Preparatory education for university admission is included in upper secondary school.) If the applicant has passed the qualifying examination for admission to a university, indicate this in the blank with *-1.( -1 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 The applicant who has more than one major at his/her university should list all majors in the blank space with *-2 *-2 Language proficiency: (1) Evaluate your ability as Excellent", Good", or Poor" in the blank space. Reading Japanese English Others( () ) Writing Speaking

10. Japanese language background, if any.() ) Name and address of institution () ) Period of study () from Year() Month() to Year() Month() Years()

11Reasons for choosing to major in the field of study entered in section 5. N.B. Specify reasons for each field of study entered in section 5. Also, ensure that the fields of study in this section are the same as the fields of study entered in section 5 ( )

Field of study and reasons First choice

Second choice

Third choice

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

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

14Description 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() Mother() Occupation() Occupation() Nationality() Nationality()

16.Immigration Records to JapanBegin with the most recent travel to Japan Date From To From To Purpose

I understand and accept all the matters stated in the Application for Japanese Government (MONBUKAGAKUSHO:MEXT) Scholarship for2014, and hereby apply for this scholarship.

2014
Date of application: Applicant's signature: Applicant's name in Roman letters capitals