APPLICATION FORM

JAPANESE GOVERNMENT

MONBUKAGAKUSHO:MEXT) SCHOLARSHIP FOR

2017

College of Technology Students for FY 2017

Type application, if possible, or write neatly by hand in block letters. )

Use Arabic numerals.

Write years in the Anno Domini system. )

Write proper nouns in full without abbreviation. )
Personal data entered in this application will only be used for scholarship selection purposes, and contact
information such as email addresses will only be used to create academic networks after the student returns
home and by the Japanese government to send out information when needed.
email

Name in full, in your native language

(Family name/Surname)

(Given name)

(Middle name)

In Roman capital letters

(Family name/Surname)

(Given name)

(Middle name)

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

Paste your photograph
Nationality
or digital image taken
within the past 6
months. Write your

Possession of Japanese nationality

No, I dont have Japanese nationality.

name and nationality in

block letters on the back

Yes, I have

Scheduled date of relinquishing Japanese nationality [year][ of

] the photo.
[month][ ]
Sex
Male

Female

photo size:4.5 cm x 3.5

Marital Status

cm

Single Married

((4.5cm3.5cm))

Date of birth and Age as of April 1,2017 ( 2017 4 1

19

Year

Month

Day

Age

(as of April 1,2017)

2017
Persons born by April 1, 1995 are not, in principle, eligible to apply for the scholarship.
1995 4

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

Present address(
Telephone/Facsimile number( /FAX
E-mail address
* If possible, write an E-mail address that can be used continuously before, during and after you stay in Japan.

E-mail

If you currently reside in Japan:

a. What is your current visa status?.
1

 b. If you intend to return to your home country, when do you plan to do so?
Month Year

Address where you will stay

If you currently reside in a country which is neither your own country nor Japan:
. a. Do you understand that, in principle, after acceptance you will apply for a visa in a diplomatic office in your home
country then be issued a plane ticket from your home country to Japan?

Yes No

b.If you intend to return to your home country, when do you plan to do so?
Month( )

Year( )

Address where you will stay

Present status with name of school attending or employer:

a) Student

b) Employment

c)

a) Student Name of school

in

b) Employment

grade / will graduate in

Year

Month

: Name of employer

c)

Field of study you specialized in at high school or university

Academic 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
( )

Name

From

Elementary School

years/levels

years

Secondary Education

Location
Name

To
From

Lower Secondary School

and

years

Location
Upper Secondary School

To

and

Name

From

*-1

years

Higher Education

Location
Name

To
From

and

years

Undergraduate Level

Location

To

and

*-2

Total of the years schooling mentioned above

As of April 1, 2017 (2017

years

1 and

months

Notes:

Exclude kindergarten education and nursery school education. ( )

Preparatory education for university admission is included in secondary education.
If the applicant has passed the university entrance qualification examinations, indicate this in the column with *-1.(

-1 )

Any school years or levels skipped should be indicated in the fourth column (Diploma or Degree Awarded, Major Subject, Skipped Years/Levels).
(Example: Graduated high school in 2 years.)

If you attended multiple schools at the same level of education due to moving house or readmission to university, then write the schools in the
same column and include the number of years of study and current status for each school.

. Calculate and write the total number of years studied based on duration as a student. (including extended leave such as summer vacation)

. You may use a separate piece of paper if the above space is insufficient. In such a case, please stipulate that the information is on a separate
page.

Have you been awarded a Japanese Government (Monbukagakusho) Scholarship in the past? Those who have received this

scholarship in the past are ineligible.

Yes, I have.

No, I have not.

If you are unsure if previously awarded student financial aid corresponds to a Monbukagakusho scholarship, please consult in
advance with a Japanese diplomatic office.

) Are you receiving a scholarship from an organization other than that of the Japanese Government (MEXT) (including an organization of
your home country government) that overlaps with the MEXT Scholarship? (Including scholarships scheduled to be received from time of
application and to be continued to be received after arrival in Japan.) ( ) (
)

No, I am not.

Yes, I am. Describe the scholarship

Preferred Field of Study and Majors and Related Key Terms in Japan
Select from the Annex Majors and Related Key Terms for Fields of Study

Field of Study

First choice

Second choice

Third choice

Majors and Related Key Terms

 Reasons for Selection of Major

Specify the reasons why you selected each Major entered in section 11. Make certain that the majors in this section are the same
as the Majors entered in section117.
( )
First choice

Second choice

Third choice

What kind of impression do you have of Japan?

What kind of occupation/profession would you like to enter after studying in Japan?
( )

 Language proficiency:

Evaluate your ability as Excellent", Good", or Poor" in each blank space.

Reading

Writing

Speaking

Japanese

English

Others(

( )

Japanese language background, if any.( )

) Name and address of institution
( )

Name of institution

Address of institution

) Period of study

( )

Visits or stays in Japan

Date

from
Year( )

Month( )

to

Year( )

Month()

Years and Months

List from your most recent visits.

Purpose

From
To
From
To

 Person to be notified in applicant's home country, in case of emergency:

( )
Name in full:

Address, telephone/facsimile number, and 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( ) Occupation( ) Nationality( )

Mother( ) Occupation( ) Nationality( )

I understand and accept all of the terms and conditions stated in the Application Guidelines for the Japanese Government
(MONBUKAGAKUSHO: MEXT) Scholarship for 2017, and hereby apply for this scholarship.
( 2017 )

Applicant's signature:

Applicant's name
in Roman capitals letters

Date of application:

2016

Year( ) month
date