APPLICATION FORM

JAPANESE GOVERNMENT

MONBUKAGAKUSHO:MEXT)SCHOLARSHIP FOR 2015

Undergraduate Students
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 building networks after the student returns home and for sending
information by the Japanese Government when necessary.

E-mail

(Sex)

Name in full, in your native language

Male

(Family name/Surname)

(First name)

(Middle name)

Female

In Roman capital letters

(Marital

Status)

(Family name/Surname)

(First name)

(Middle name)

Single

Write your name exactly as it appears in your passport.

Married(

)
-1 Nationality -2 Possession of Japanese nationality Yes, I have
Paste your photograph
No, I dont have
or digital image taken
within the past 6
months. Write your
name and nationality in
block letters on the back
of the photo.

Date of birth and Age as of April 1,2015( 2015 4 1

19 Age
Year

Month Day as of April 1, 2015 2015

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

E-mail
Home 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. Email

Preferred field of study in Japan

Select from the fields of study stipulated under 1.FIELDS OF STUDY in Application Guidelines.(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

in

( )

grade / will graduate in

Year

Month

Those in employment Name of employer

Educational background:
Name and Address of School

Year and Month

Duration of

Diploma or Degree awarded,

of Entrance and

Attendances

Major Subject, Skipped

Completion

Elementary Education

From

Name

( )

Elementary School

years/levels

years

Secondary Education

Location
Name

To
From

Lower Secondary School

and

years

Upper Secondary School

Location
Name

To
From

and *-1

years

Higher Education

Location
Name

To
From

Undergraduate Level

and

*-2

years

Location
To
Total of the years schooling mentioned
above

and

years

As of April 1, 2015

and

(2015 4 1 )

months

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, skipping the 3 rd year.)

 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 each 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 Reasons for choosing to major in the field of study entered in section 5.

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

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 occupation 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

Home 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
Date

Begin with the most recent travel to Japan

Purpose

From
To
From
To

I understand and accept all the matters stated in the Application Guidelines for Japanese Government (MONBUKAGAKUSHO:MEXT)
Scholarship for2015, and hereby apply for this scholarship.

2015

Date of application:

Applicant's signature:

Applicant's name

in Roman block letters capitals