KANDEN-SS SCHOLARSHIP APPLICATION FORM 2019

(This application form should be written clearly and completed in English. Typing is preferable)

Application form can be downloaded from http://www.hcmut.edu.vn/ Applicant number (fill

The original and all required documents should be submitted at the below address: by selection
committee):
Contact and Mailing Address:
Ms. Thai Hoang Chi An - External Relations Office
Address: Room 102 – Building A5 - 268 Ly Thuong Kiet, District 10, HCMC
E-mail: thchian@hcmut.edu.vn
All pages 1 through 3
IMPORTANT DATES: must be thoroughly
(1)Submission deadline of applications: 31st of May annually filled in
(2)Submission deadline of candidate list to KSS: mid of June annually
(3)Application screening date: end of June annually
(4)Notification of scholarship awarding: early September annually
(5)Scholarship awarding ceremony: September or October annually

It is advisable to provide detailed information and description for each item below, and attach supporting
documents when necessary

SECTION 1 - PERSONAL INFORMATION

Applicant Name:

ID Photo 3 x 4cm
DO
________________________ THINH
___________________ HUU
________________
Last name First name Middle name

Gender Male  Female  Date of birth Month:_11___ Date_04__ Year_1998

Present Address Telephone:

497 Hoa Hao, block 7, district 10, Ho Chi Minh City
Mobile: 0823485457

Permanent Address: 33B/33 block 5, Ho Nai, Bien Hoa, Dong Email address:
Nai 1613342@hcmut.edu.vn
Preferred contact address: (can √ tick more than one)
 Present Address  Permanent Address  Email  Telephone  Mobile

SECTION 2 - EDUCATION
A. CURRENT UNIVERSITY
Name of university Student ID
HOCHIMINH CITY UNIVERSITY OF TECHNOLOGY 1613342

Department/Faculty Major of Study MECHATRONICS - PFIEV

FACULTY OF MECHANICAL ENGINEERING

Current Academic Year  First  Second  Third  Fourth Fifth

Academic record : Talent Class:
8.55  Yes  No
the 2nd semester of the last academic year :

the 1st semester of the current academic year: 8.88

B. GENERAL
1. Honors/Awards/Scholarship History (Include amounts and effective dates)

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 KANDEN-SS SCHOLARSHIP APPLICATION FORM 2019
From (DD/MM/YY) To(DD/MM/YY) Name/Description of Scholarship

2. Extracurricular/Community Activities (Include school and community activities in order of importance)

From (DD/MM/YY) To(DD/MM/YY) Name/Description of Activities

01/12/2017 31/12/2017 ADVISING EDUCATION ENROLLMENT - 2017

01/12/2017 31/12/2017 FRENCH CULTURE DAY 2017

01/12/2016 31/12/2016 FRENCH CULTURE DAY 2016

3. English language skills
Speaking Listening Writing Reading
 Excellent Good  Excellent  Good  Excellent Good  Excellent Good
 Fair  Poor  Fair  Poor  Fair  Poor  Fair  Poor
4. Japanese language skills

 Excellent  Good  Excellent  Good  Excellent  Good  Excellent  Good

 Fair  Poor  Fair  Poor  Fair  Poor  Fair  Poor

SECTION 3 – FAMILY INFORMATION (Father, mother, wife/husband, children, brothers and sisters)
Relative Full-name Age Occupation Work place or present address
Father Do Huu Thien 57 Farmer 33B/33 block 5, Ho Nai, Bien Hoa,
Dong Nai

Mother Doan Thi Thuy Nhung 46 Farmer 33B/33 block 5, Ho Nai, Bien Hoa,
Dong Nai
Brother Do An Khang 15 Student 33B/33 block 5, Ho Nai, Bien Hoa,
Dong Nai
Sister Do Thi Thuy Trang 24 Worker 33B/33 block 5, Ho Nai, Bien Hoa,
Dong Nai

SECTION 4 - SCHOLARSHIP

1. Have you ever taken a Japanese course?

 Yes ________________________________ No 
(If yes, please attach the certificate(s) of Japanese Proficiency)
2. Have you ever participated in a movement/ activity aiming at contributing /promoting the exchange of
culture between Japan and Vietnam?
 Yes ________________________________ No 
(If yes, please specify or attach certificate(s) of the movement/activity participation)
3. Have you ever received any scholarship from Kanden-SS Scholarship Fund?
 Yes ________________________________ No 
(If yes, please specify the type of scholarship)
4. Do you agree to participate in Kanden SS’s business?
Strongly agree  Agree  No idea  Disagree 

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 KANDEN-SS SCHOLARSHIP APPLICATION FORM 2019

SECTION 5 – DOCUMENT CHECKLIST

Document checklist: Compulsory
1 Application form
2 Academic record of the 2nd semester of the last academic year and of the 1 st semester of the
current academic year
3 At least one recommendation letter of the dean or head of the department or research supervisor
or class head teacher
4 Motivation Letter
5 Any certificate
6 Japanese proficiency certificate (if any)

CERTIFICATION AND RELEASE AUTHORIZATION

I certify that all the information included in this application and attached documents is complete, correct and
true to the best of my knowledge. I authorize the release of information concerning my background, academic
and financial status to confirm and verify this application.

Signature: Date: (day)_____/(month)______/(year)______

Note: Kanden-SS Scholarship Program 2019 will not consider illegible, incomplete application packages,
or documents reaching the given address after the deadline (both of original and scan documents).
Applications will not be returned.

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