APPLICATION FOR JAPANESE GOVERNMENT ( MONBUKAGAKUSHO: APPLICATION FOR JAPANESE GOVERNMENT ( MONBUKAGAKUSHO: APPLICATION FOR JAPANESE GOVERNMENT ( MONBUKAGAKUSHO:

BUKAGAKUSHO: APPLICATION FOR JAPANESE GOVERNMENT ( MONBUKAGAKUSHO: MEXT) SCHOLARSHIP MEXT) SCHOLARSHIP MEXT) SCHOLARSHIP MEXT) SCHOLARSHIP

Teacher Training Students for 2014

INSTRUCTIONS
The application should be typewritten, if possible, or neatly handwritten in block letters.)
Numbers should be in Arabic figures.)
Year should be written in the Anno Domini system. )
Proper nouns should be written in full, and not be abbreviated. )
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 for forming academic networks after the student returns home and for sending information from the Japanese Government.
email


(Sex)
Name in full, in native language Ahmad Siti Fatimah binti Male
)) (Family name) (First name) (Middle name) Female
(Marital Status)
In Roman capital letters AHMAD SITI FATIMAH BINTI Single
(Family name) (First name) (Middle name) Married()
(Please write your name exactly as it appears in your passport.)

2-1 Nationality 2-2 Japanese nationality Yes, I have
No, I dont have

MALAYSIAN

Date of birth(*as of April 1, 20142014 4 1
1984 4 2 Age 29
Year Month Day

Present status (name of employer)

Your status/occupation:
Science Teacher


Name of the institution where you are employed:
Sekolah Menengah Kebangsaan ABCD

Present type of work (Describe teaching subjects or work duties.)
)

Teaching Science Subjects to Form 3 Students, Advisor for Basketball Club

Present address, telephone/facsimile number, and email address
email
Present address(1234, Jalan 567, Taman ABCD, 5xxxx Kuala Lumpur
Telephone/facsimile number(/FAX (H/P) 013-xxxx-xxxx; (Fax) 03-yyyy-yyyy
Email address xxxx@xxxx.xxxx
If possible, write an email address that can be used for periods including the time before you come to Japan, during your stay in Japan, and the period after you
return home.email

Field of study specialized in a university or teacher training school in the past (Be as concrete as possible.)
)


1
Paste your photograph or
digital image taken within
the past 6 months. Write
your name and nationality
in block letters on the
back of the photo.

(4.5cm3.5cm photo)
4.53.5
Proposed study program in Japan (In more than 300 words, state the outline of your major field of study and study program. This section will be used as one of
the most important references for selection. Your statement must be typewritten or written in block letters. Additional sheets of paper may be attached if
necessary.)
300
)

Those who desire multiple research topics, may indicate as many as two research plans. If you do so, please indicate them clearly by itemizing such selections.
Also, selected universities and fields on the Placement Preference Application should be related to this research plan. (Example: If you select mathematics education
research as your first choice and scientific education research as your second, you may indicate their respective research plans in this column/space. In doing this, be
certain to select a university/ teaching field from the Course Guide, which offers the mathematics and science education research training program that you desire, and
indicate it in the Placement Preference Application.

If possible, write in Japanese.
)



No guidance will be given for this part.

(continued)
Academic background:


Name and Address of School


Year and Month of
Entrance and Completion

Duration of
Attendance

Diploma or Degree Awarded,
Major Subject, kipped years/levels


Elementary Education
()
Elementary School

Name
()
SK ABCD
Location
()
Kuala Lumpur
From

Jan 1991
To

Dec 1996
yrs
6

and
mons

UPSR
Secondary Education

Lower Secondary School

Name
()
SMK ABCD
Location
()
Kuala Lumpur
From

Jan 1997
To

Dec 2001
yrs
5

and
mons

PMR, SPM
Upper Secondary School

* Includes Foundation,
Matriculation, Diploma
Name
()
SMK EFGH
Location
()
Kuala Lumpur
From

Jun 2002
To

Dec 2003
yrs
1

and
6 mons

STPM
Name
()
XYZ College
Location
()
Selangor
From

Sep 2004
To

Aug 2006
yrs
3

and
mons

Diploma in Education
Higher Education

Undergraduate Level

* Bachelors degree only
Name
()
PQRS University
Location
()
Perak
From

Sep 2006
To

Aug 2007
yrs
1

and
mons

*-1

Bachelor of Education
(Teaching Science)
Graduate Level

Name
()
nil
Location
()

From


To


yrs


and
mons

nil
Total number of years of the aforementioned schooling


16 yrs
and
6 mons
If the blank spaces above are insufficient for the information required, please attach (a) separate sheets.
(() )
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/levels).
(Example: Graduated high school in 2 years, etc.)




10Employment record as teachers at elementary or secondary educational institutions or teacher training schools : Begin with the most recent employment.


Name and location of organization


Period of employment


Position


Type of work


Sekolah Menengah Kebangsaan ABCD
No. xxx, Jalan yyy, Taman zzz, xxxxx Kuala Lumpur
from Sep 2007
to current
Teacher
Teaching science subjects, Advisor for
Basketball Club

from
to


from
to

Period of all employment

6 Year *as of April 1,20142014 4 1

11State the titles or subjects of books or papers(including graduation thesis authored by applicant), if any, with the name and address of publisher and the date of
publication.())




12Japanese language background, if any.

Name of institution nil


Address

Period of study nil from to
YearMonth YearMonth Years

Japanese language proficiency: Evaluate your ability and fill in with an X where appropriate in the blanks.



Excellent

Good

Poor

Reading

x
Writing

x
Speaking

x

13Foreign language proficiency: Evaluate your ability and fill in with an X where appropriate in the blanks.



Excellent

Good

Poor

English

x
French


German


Spanish


Others( Malay )

x

14Have 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.

15. 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 the various difficulties and great
expense that will be involved in finding living quarters for them. Therefore, those who want to accompany their families are well advised to come alone first and
let them come after suitable accommodation has been found.
()


Name )
Relationship
( )
Age

nil



16. Person to be notified in applicant's home country in case of emergency:
()

Name in full: Ahmad bin Abdul Halim


Addresstelephone/facsimile number, and email address
)
Present Address( No. 1234, Jalan 5678, Taman ABCD, xxxxx Kuala Lumpur
Telephone/facsimile number(/FAX 03-yyyy-yyyy
Email address zzzzz@zzzz.zzz

Occupation: Businessman


Relationship to applicant: Father


I understand and accept all the matters stated in the Application for Japanese Government (MONBUKAGAKUSHO: MEXT) Scholarship for 2014 and hereby
apply for this scholarship.
2014

Date of application:
XX January 2014

Applicant's signature:


Applicant's name
in Roman capital letters SITI FATIMAH BINTI AHMAD


(
)

PLACEMENT PREFERENCE APPLICATION FORM FOR JAPANESE GOVERNMENT (MONBUKAGAKUSHO: MEXT) SCHOLARSHIP


Teacher Training Students for 2014

Name in full in Roman capital letters

(Sex)
AHMAD SITI FATIMAH BINTI Male
(Family name) (First name) (Middle name) Female


Nationality MALAYSIAN


University and teaching field(s) of specialty to which you wish to attend(
(Please choose the university and teaching field(s) of the specialty you wish to attend from those listed in theCourse Guide".
Make sure in advance that your selected teaching field(s) can be provided at the university that you want to attend.)
()
Select the university and field of your choice. Please verify that the field you select is offered at the university of your choice.
First choice
Hokkaido University of Education Science Education 01011

Name of university teaching field Course code


Second choice
Akita University Science Education 05013

Name of university teaching field Course code


Third choice
University of Tsukuba Science Education 09016

Name of university teaching field Course code

If it is not possible for you to be admitted to one of the above universities, do you have an alternative study plan?
Please mark a) or b) below.
()

a) I will study at a university designated by MEXT. ()

b) I will withdraw my application to study in Japan.

Do you have any intentions of immediately returning to your country upon completing the program and resuming to work, and utilizing the fruits of your research
in a teaching capacity?
(

a) Yes. (

b) No. (
,
Paste your photograph or
digital image taken within
the past 6 months. Write
your name and nationality
in block letters on the
back of the photo.

(4.5cm3.5cm photo)
4.53.5