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 ( M O N B U K A G A K U S H O : M ) S C H O L A R S H I P

Research Students for 2012

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

In Roman capital letters

(Family name/Surname)

(Marital Status) (First name) (Middle name) Single Married() Yes, I have No, I dont have

(Please write your name exactly as it appears in your passport). Nationality 2-2Possession of Japanese nationality

Paste your photograph or Date of birth( 19 Year Month Day Age (as of April 1,2012) 2012 digital image taken within the past 6 months. Write your name and nationality in block letters on the back Present status with the name of the university attending or employer 4.5cm3.5cm photo
((4.5cm3.5cm))

of the photo.

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 pastBe as detailed and specific as possible.)

Educational background

Name and Address of School

Name () Elementary Education () Elementary School Location ()

Year and Month of Entrance and Completion () From

Duration of Attendances years

Diploma or Degree awarded, Major subject, Skipper years/levels

To

and months

Name () Secondary Education Lower Secondary School Location ()

From

years

To

and months

Name () Upper Secondary School

From

years

Location ()

To

and months

Name () Higher Education Undergraduate Level Location ()

From

years

*-1

To

and months

Name () Graduate Level

From

years

Location ()

To

and months

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. () 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 From To Period of employment Position Type of work

From To

10Japanese language proficiency: Evaluate your level and insert an X where appropriate in the following blank space. Excellent Reading Writing Speaking Good Fair Poor

11Foreign language proficiency: Evaluate your level and insert an X where appropriate in the following blank space. Excellent English French German Spanish Others( () ) Good Fair Poor

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

13Proposed 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. ) No, I have not. Period: University:

15Accompanying 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.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 for 2012, and hereby apply for this scholarship 2012

Date of application:

Applicant's signature:

Applicant's name in Roman letters capitals