Select a place of examination (Mark )

Bangkok

Chiang Mai

Khon Kaen

Songkla

APPLICATION FORM (THAILAND)

JAPANESE GOVERNMENT (MONBUKAGAKUSHO: MEXT) SCHOLARSHIP FOR 2016
UNDERGRADUATE STUDENTS

Registration No.

INSTRUCTIONS
The application should be typed if possible, or neatly handwritten in block letters.
Numbers should be in Arabic numerals.
Year 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 of information by the Japanese Government.
E-mail

Name in full, in native language

(Sex)

Male
(Family name)

(First name)

(Middle name)

(Family name)

(First name)

(Middle name)

Female

In Roman block letters

(Marital Status)
Single

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

2. Nationality

2-2 Japanese nationality

Married()

Yes

Paste a passport sized

No

photograph taken within the

Date of birth(
19

past 6 months. Write your

Age

Year

Month

Day

name and nationality in

as of April 1, 2016 2016

block letters on the back of

the photo.

Present address and telephone number, facsimile number, e-mail address

E-mail

4.5cm3.5cm photo

Present address(

((4.5cm3.5cm))

Telephone/Facsimile number(/FAX
Mobile ()
E-mail address
If possible, write an e-mail address where we can contact you for periods that include the time before you come to Japan, your stay in Japan and the period
after you return home. E-mail
Chosen field of study in Japan (please check X)
Select from 1.FIELDS OF STUDYin Announcement.
Fields of Study
U1

U2

Subjects

Social Sciences and Humanities

English, Mathematics (A)

Natural Sciences A

English, Mathematics (B), Chemistry, Physics

Natural Sciences B

English, Mathematics (B), Chemistry, Biology

Natural Sciences C

6.

Chosen majors in Japan (Please complete it all 3 choices within the same Field of Study in page 1 in Announcement Form)
First Choice

Second Choice

Third Choice

7Would you like to take Japanese Language Test given for evaluation for those who are in the programme of Japanese language
and those who would like to be evaluated their Japanese language skills?

Yes

No

8Field of study you specialized in at high school or university

9Present status with name of school attending/attended or employer:

in
grade

Student Name of school

()

/ will graduate in

Year

Month

Those in employmentName of employer

10Educational background:
Name and Address of School

Elementary Education

Name
)

Year and Month

of Entrance and
Completion

From

years

To

and
months

From

years

To

and
months

From

years

To

and
months

From

years

()
Elementary School

Location
)

Secondary Education

Name
)

Lower Secondary School

Location
)

Name
)

Location
)

Diploma or Degree awarded,

Major Subject, Skipped years/levels

*-1

Upper Secondary School

Duration of
Attendances

*-2
Higher Education

Name
)

Undergraduate Level

Location
)

To

Total of the years schooling mentioned above

As of April 1, 2016
(2016 4 1 )

1)

2)
and
months
3)

years
and
months

Notes: 1. In Thailand, elementary school is for 6 years, lower secondary school is for 3 years, upper secondary school is for 3 years and university is for 4 years.
Those who skipped class, the total years of education are decreased. ( 6 3 3 4
)
2Exclude kindergarten education or nursery school education. ()
3Include preparatory education for university admission in upper secondary school.)
4If the applicant has passed the qualifying examination for admission to a university, indicate this in the blank with *-1.(
-1
5. 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

6The applicant who has more than one major at his/her university should list all majors in the blank space with *-2
*-2

G.P.A

11Language proficiency:
(1) Evaluate your ability as Excellent", Good", or Poor" in the blank space.

Reading

Writing

Speaking

Japanese

English

Others(
()

Specify the test results for any English proficiency examinations you may have taken.
PTE Academic

points

TOEIC

points Others

TOEFL

points IELTS

points

points ()

Have you ever passed the Japanese Language Proficiency Test? Please Mark either (1) or (2) with a circle. If you marked (1), please state your level.
(1) Yes, I have.
Japanese Language Proficiency Test

Level

__________

(2) No, I have not.

12. Japanese language background, if any.()
1) Name and address of institution
()
2) Period of study
()

from

to
Year()

Month()

Total:
Year()

Years

Month()

13Reasons for choosing to major in the field of study described in item no.6 (page 1). *Specify the reasons for each field of study entered in item no.6. Also, ensure
that the fields of study in this section are the same as the fields of study entered in item no.6
(6

Field of study and reasons

First choice

Second choice

Third choice

14What kind of field are you planning to study in Japan?

()

15What kind of impression do you have of Japan?

16. Description of desired employment to be taken up after returning home.

()

17.Immigration Records to JapanBegin with the most recent travel to Japan

Date

Purpose

From
To
From
To

18. 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 with the applicant:

I understand and accept all the matters stated in the Application for Japanese Government (MONBUKAGAKUSHO:MEXT) Scholarship for 2016, and hereby apply
for this scholarship. 2016
Date of application:

Applicant's signature:

Applicant's name
in Roman block letters

( 4 )
1.
1
2. Admission Form ( )
1
3. Admission Form (4.53.5 cm)
3
4.
1
5. 1
6.
1
( )
7. JLPT ( )
1
8. EJU ( )
1
*

**
**

1.
2. 5-15 1
3. (11-12 2558)
2-3

( 8-12 2558
13.30 -16.30 .)
4. (Fields of Study )