Professional Documents
Culture Documents
In addition to the application form, the following "Supporting Documents" are required.
Please select YES or NO to ensure that your application is complete and that you have enclosed all documents listed below.
AUN/SEED-Net WILL NOT consider any application with incomplete documents.
* Please note that applications without an endorsement letter will not be accepted.
Document Checklist
Please answer Yes/No in the space provided for items submitted.
Compulsory
1. This application form completed with photo & signature
2.
3.
4.
5.
6.
Cover Page
Name:
Endorsed by:
0
Application
University
Field of Study
0
Photo
(Taken within
the past 6 months)
Email
Mobile
Tel/Fax
Please kindly provide valid contact information. Japanese Supporting University may contact the applicant directly for interview, or request additional information for the screening.
Endorsed by Sending Institution (SI)
* Please note that applications without an Endorsement Letter will not be accepted.
Section 2: Academic Qualification
Educational Record (Higher Education)
Please list all degrees received.
Period
No.
Institution/University
From (Month/Year)
To
Degree
Major
(Month/Year)
Status
Class Rank
No.
Institution/University
department/
program
Degree
Placed at rank
Total Number
(Students)
CGPA
Signed by
(Name)
To verify your Class Rank, please submit Certified letter on academic standing (Attachment 1)
Thesis Topic
Please submit Thesis Abstract for the previous
degree received (if any).
English Qualification (if any, please submit the certificate)
English Proficiency Test
Score
Taken Date (MM/DD/YYYY)
Organization
From (Month/Year)
To
City/Country
(Month/Year)
Section 4: Achievements
Other Awards (Additional page should be submitted as a separate file.)
Page no. 1 of 2
Position/Title
Selection
University
Program/Department/
Faculty
Intake
Field of Study
Division
Proposed Advisor
Semester
Year
Please specify
Please specify
2. Medical History
(a) Have you had any significant or serious illness?
Please specify
(b) Have you ever been a patient in a mental clinic or been treated by a psychiatrist?
Please specify
Section 9: Declaration
I declare that all information in this application as well as the attached documents are true and correct to the best of my knowledge. I acknowledge that the provision of incorrect information or supporting documents may result in
termination of scholarship, and that I will have to be responsible for an expenses incurred from my misinformation.
If awarded the scholarship, I agree:
(a)to abide by the rules and regulations of the Host Institution, Japanese Supporting University, AUN/SEED-Net Project, and JICA;
(b)to follow course regulations and instructions and abide by such conditions as may be stipulated by both the host institution, Japanese Supporting University, and AUN/SEED-Net in respect of this course of study;
(c)to refrain from engaging in political activities, or any form of employment for profit;
(d)to submit any progress reports or evaluation questionaire which may be prescribed;
(e)to return to my home country at the end of my scholarship period.
I also fully understand that, the scholarship, if awarded, may be subsequently withdrawn for failure of making adequate progress, or for other sufficient cause including health condition as determined by AUN/SEED-Net.
Please specify
Date:
Page no. 2 of 2
Questions
1. First Name
2. Family Name
3. Gender
4. Nationality
5. Date of Birth
(MM/DD/YYYY)
SN ID
1
2
3
4
5
Section
Topic
Personal Information
Items
Answers
0
0
0
0
30-Dec-1899
6. Age
7. Marital Status
8. Present Position
9. University/Organization
10. Department/Division
6
7
8
9
10
11
Current Status
Contact Information
0
0
0
0
0
0
12. Email
13. Mobile
14. Tel/Fax
Endorsed by SI
[1] Degree
[1] Institution/University
12
13
14
15
16
17
Contact Information
Degre
0
0
0
0
0
0
[1] Major
[1] Period: To
(Month/Year)
[1] CGPA
[1] Status
[2] Degree
18
19
20
21
22
23
Degree (1)
0
30-Dec-1899
30-Dec-1899
0
0
0
[2] Institution/University
[2] Major
[2] Period: To
(Month/Year)
[2] CGPA
[2] Status
24
25
26
27
28
29
Degree (2)
0
0
30-Dec-1899
30-Dec-1899
0
0
[3] Degree
[3] Institution/University
[3] Major
[3] Period: To
(Month/Year)
[3] CGPA
30
31
32
33
34
35
Degree (3)
0
0
0
30-Dec-1899
30-Dec-1899
0
[3] Status
[1] Institution/University
[1] Degree
[1] department/
program
36
37
38
39
40
41
2: Academic Qualification
Clas
0
0
0
0
0
0
[1] CGPA
[1] Signed by
(Name)
[2] Institution/University
[2] Degree
[2] department/
program
42
43
44
45
46
47
0
0
0
0
0
0
48
49
50
Thesis
English
Qualification
English Qualification
English Qualification
English
Qualification
Thesis Topic
Thesis
[2] Signed by
(Name)
53
[2] CGPA
52
51
Score
Taken Date
(MM/DD/YYYY)
[1] Organization
[1] Period: To
(Month/Year)
[1] City/Country
54
55
56
57
58
English Qualification
59
English Qualification
Job (1)
0
30-Dec-1899
0
30-Dec-1899
30-Dec-1899
0
60
61
62
63
64
65
[1] Position/Title
[2] Organization
[2] Period: To
(Month/Year)
[2] City/Country
Job (2)
30-Dec-1899
30-Dec-1899
[2] Position/Title
[3] Organization
[3] Period: To
(Month/Year)
[3] City/Country
66
67
68
69
70
71
nt Record
aduation)
(Max. 3)
Job (3)
0
0
0
30-Dec-1899
30-Dec-1899
0
[3] Position/Title
(1) University
(1) Department/Faculty
72
73
74
75
76
77
Section 4:
Achievements
Section 5: program Selection
1 Selection
Achievements/
Awards
1st Priority
0
0
0
0
0
0
78
79
80
81
82
83
6.2 Publications
(journal,
6.1 Research
proceedings,
Title
etc). Within 2
years
1 Selection
(1) Division
1st Priority
84
85
86
87
88
Section 7:
Statement of
Purpose
89
Statement of
Purpose
Please specify 0
Past (a)
Present (a)
Present (B)
Statement of Purpose
Please specify 0
90
91
92
93
Record
94
95
Section 9: Declaration
Please specify 0
Please specify 0
Section 9: Signed
Past (B)
30-Dec-1899
B Certificate
B Transcript
M Certificate
M Transcript
1
2
3
4
5
6
Cover Page
Document Checklist
Compulsory
0
0
0
0
0
0
Research Proposal
Certificate of English
Proficcienty
Endorsement Letter
Recommodation Letter
Copy of Publication
7
8
9
10
11
Cover Page
Document Checklist
Compulsory
0
0
0
0
0
0
0
Other