A P P L I C AT I O N F O R J A PA N E S E G OV E R N M E N T ( M O N B U K A G A KU S H O : M

) S C H O L A R S H I P

Research Students for 2014

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)
Male

Name in full in your native language

)) (Family name/Surname)

In Roman capital letters

(First name)

(Middle name)

(Marital Status)

(Family name/Surname)

Female

(First name)

(Middle name)

Single
Married( )

(Please write your name exactly as it appears in your passport).

2-2 Possession of Japanese nationality Yes, I have

Nationality

No, I dont have

Date of birth(

Paste your photograph

19
Year

or digital image taken

Month

Day Age (as of April 1,2014) 2014

within the past 6

months. Write your

name and nationality in

Present status with the name of the university attending or employer

block letters on the

back of the photo.

4.5cm3.5cm photo
((4.5cm3.5cm))

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

E-mail

Present address
Telephone/facsimile number /FAX
Email address
* If possible, write an email 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 past Be as detailed and specific as possible.)

 Educational background
Name and Address of School

Year and Month

Duration of

Diploma or Degree awarded,

of Entrance and

Attendances

Major subject, Skipper

Completion

years/levels

( )

Elementary Education
( )

Name

( )

From

years

Elementary School

Location

( )

To

and

months

Secondary Education

Name

( )

From

years

Lower Secondary School

Location

( )

To

and

months

Upper Secondary School

Name

( )

From

years

Location

( )

To

and

months

Higher Education

Name

( )

From

*-1

years

Undergraduate Level

Location

( )

To

months

and

Graduate Level

Name

From

( )

years

Location

To

( )

and

months

Total years of schooling mentioned above

Years and

months

As of April 1,2014
(2014

* 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. ( )

Preparatory education for university admission is included in upper secondary school.

If the applicant has passed the university entrance qualification examination, 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

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

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

Excellent

Good

Fair

Poor

Reading

Writing

Speaking

If you have taken the Japanese Language Proficiency Test, specify the level you acquired. Level
( )

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

Excellent

Good

Fair

Poor

English

French

German

Spanish

Others(

( )
Specify the test results for any English proficiency examinations you may have taken. TOEFL
IELTS

points PTE Academic

point

points Others points ( )

12 The 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

13 Proposed period of study

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

14 Have 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:

Type:

University:

) No, I have not.

15 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

( )

16. 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:

17.Visits or stays in Japan

Date

List from your most recent visits.

Purpose

From

To
From

To

I understand and accept all the matters stated in the Application for Japanese Government (MONBUKAGAKUSHO:MEXT) Scholarship
for 2014, and hereby apply for this scholarship.
2014

Date of application:

Applicant's signature:

Applicant's name
in Roman letters capitals