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 2011

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)

(First name)

(Middle name)

(Marital Status)

In Roman capital letters

(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

Paste your photograph

or digital image taken

Date of birth(

within the past 6

19
Year

months. Write your

Month

Day Age (as of April 1,2011) 2011

name and nationality in

block letters on the back
of the photo.

Present status with the name of the university attending or employer

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

and

months

Graduate Level

Name

From

( )

years

Location

To

( )

and

months

Total years of schooling mentioned above

Years and

months

As of April 1,2011
(2011 )

* 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

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
( )

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 Term you wish to study in Japan
Please mark either ), ), ) or ) with a circle.
* Please refer to item 3 titled Term of Scholarship in the document titled Japanese Government Scholarship for 2011 for more
information on the term
of scholarship and the conditions for extending the term.

) Only a research students term (two years or one year and six months)
) Until the masters degree course completion
) Until the doctoral course completion

) Until the professional graduate course completion

15 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:

University:

) No, I have not.

16 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

( )

17. 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:

18.Immigration Records to Japan

Date

Begin with the most recent travel to Japan

Purpose

From
To

From
To

I understand and accept all the matters stated in the Application for Japanese Government (MONBUKAGAKUSHO:MEXT) Scholarship
for 2011, and hereby apply for this scholarship
2011

Date of application:

Applicant's signature:

Applicant's name
in Roman letters capitals