APPLICATION FOR JAPANESE GOVERNMENT

MONBUKAGAKUSHO:MEXT) SCHOLARSHIP

Specialized Training College Students for 2013

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
information by the Japanese Government.

E-mail

(Sex)

Name in full, in your native language

Male

(Family name/Surname)

(First name)

(Middle name)

Female

In Roman capital letters

(Family name/Surname)

(Marital Status)

(First name)

(Middle name)

Single
Married( )

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

-1 Nationality -2 Possesion of Japanese nationality Yes, I have

No, I dont have

Paste your photograph

or digital image taken
within the past 6

months. Write your

Date of birth(

name and nationality in

block letters on the back

19 Age
Year

Month Day as of April 1, 2013 2013

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

of the photo.
4.5 x 3.5 cm photo
((4.5cm3.5cm))

E-mail
Present address(
Telephone/Facsimile number( /FAX
E-mail address

If possible, write an e-mail 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

Chosen field of study and subjects in Japan

N.B. Select from Majors and Related Subjects for Fields of Study. If you enter a second choice, ensure that it is from the same field of
study as your first choice.

Field of study
First choice of subjects

Second choice of subjects

Field of study you specialized in at high school or university

Present status (with name of school attending or employer)

Student Name of school

in

( )

grade / will graduate in

Year

Month

Those in employment Name of employer

Educational 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
( )

From

Name
)

years/levels

years

Elementary School

Secondary Education

Name

From

years

Lower Secondary School

Upper Secondary School

Location
Name

To
From

and *-1

years

Higher Education

Location
Name

To
From

and

years

Undergraduate Level

*-2

Location
To
Total of the years schooling mentioned
above

and

years

As of April 1, 2013

and

(2013 4 1 )

months

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 qualifying examination for admission to a university, 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.)

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

*-2

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

Reading

Writing

Speaking

Japanese

English

Others(

( )
10. Japanese language background, if any.( )
) Name and address of institution
( )

) Period of study

( )

from to
Year( )

Month( )

Year( )

Month()

Years( )

11 Reasons for choosing to subjects entered in section 5. N.B. Specify reasons for each subjects entered in section 5. Also, ensure that
the subjects in this section are the same as the subjects entered in section 5.
(
Subjects and reasons
First choice of subjects

Second choice of subjects

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

( )

13. What kind of impression do you have of Japan?

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

( )

15. 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:

name(s) of family member(s):

Father( ) Occupation( ) Nationality( )

Mother( ) Occupation( ) Nationality( )

16.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 2013, and hereby apply for this scholarship.
2013

Date of application:

Applicant's signature:

Applicant's name

in Roman letters capitals