A P P L I CA T I O N F O R JA PA N E S E G O V E R N M E N T

MONBUKAGAKUSHO:MEXT

SCHOL ARSHIP

Japanese Studies Students for 2014

INSTRUCTIONS
The application should be typewritten, if possible, or neatly handwritten in block letters. )
Numbers should be in Arabic figures ( Angka Latin). )
Years should be written in the Anno Domini system ( Masehi ). )
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

Name in full, in native language

(Sex)

Male

(Family name)

(First name)

(Middle name)

Female

In Roman capital letters

(Marital Status)

(Family name)

(First name)

(Middle name)

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

2-1 Nationality 2-2 Japanese nationality

Single
Married( )

Yes, I have

No, I dont have

Paste your photograph

or digital image taken
within the past 6
months. Write your
name and nationality

Date of birth ( * as of April 1, 2014 2014 4 1

back of the photo.

19 Age
Year

Month

in block letters on the

4.5cm3.5cm photo

Date

4.53.5

Present address, telephone/facsimile number, and email address

FAX -mail
Present address (
Telephone/HandPhone( /
Email address
If possible, write an email address that can be used continuously for periods including the time before you come to Japan, during your
stay in Japan, and after you return home. email

 Chosen specialized courses of study in Japan

Which choice do you prefer ? Please mark a) or b) below. )
a) A course conducted mainly about Japan and Japanese culture with supplementary study to improve Japanese language proficiency.

b) A course conducted mainly to improve students Japanese language proficiency with supplementary study about Japan and
Japanese culture.

What academic field do you want to study in Japan? ( )

If possible, please write in Japanese.

( )

Field of study specialized in the past at your high school, college, or university.

University currently attending:

Faculty/School:

Major:

Minor:

in

year ( )

*as of April 1, 2013 2013 4

Be filled with concrete learning content

Scheduled to graduate in
month

year

 Academic background:
Name and Address of School

Year and Month

Duration of

Diploma or Degree Awarded,

of Entrance and

Attendance

Major Subject, kipped

Completion

Elementary Education
( )

Name

From

years/levels

years

Elementary School

Secondary Education

Location
Name

To
From

and

years

Lower Secondary School

Upper Secondary School

Location
Name

To
From

and
*-1
years

Higher Education

Location
Name

To
From

and

years

*-2

Undergraduate Level

Location

To

and

months

Total number of years of the aforementioned

schooling

years

and

* as of April 1, 2014 2014 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 university entrance qualification examinations, 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.)

Indicate the main subjects in the blank that have been already taken (including those being taken now ) in the university
currently enrolled with *-2. 2
10 Language ability:
(1) Evaluate your ability as Excellent," Good, or Poor" in the blanks.

Reading

Writing

Speaking

Japanese

English

French

Other (
( )

11. Japanese language background, if any. ( )

) Name of institution

( )

Address
( )

) Period of study

( )

from to

Year ()

Month ( )

Year ( )

Month ( )

Years ( )

12 Qualification document certifying Japanese-language ability

Name of qualification (
13 Description of desired employment to be sought after returning to your home country.
( )
14 Have you been awarded a Japanese Government (Monbukagakusho) Scholarship in the past? Please mark ) or ) below.

If so,

please specify the period, the name of the university, etc.

) Yes, I have.

Period:

University:

) No, I have not.

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

Name in full:

Address with telephone/facsimile number, and email address

mail )
Present Address(
Telephone/facsimile number( /FAX
Email address

Occupation:

Relationship to applicant:

name(s) of family member(s):

Father ( )

Occupation

Nationality

Mother( )

Occupation

Nationality
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

16.PilihanTempatUjian:

Date of application:

A. Jakarta

B.

Medan

C.

Surabaya

Applicant's signature:

D. Makassar

Applicant's name

(in Roman capital letters)

E.

Denpasar

(LingkariSalahSatu)