APPLICATION FORM
Ajinomoto Scholarship for ASEAN International Students
「 」
Please type or write in Japanese or in English block letters.
(
)
Numbers should be Arabic numerals. ( )
Years should be written using the Anno Domini system. (
)
Proper nouns should be written in full and not abbreviated. ( )
Please
fill your Write
language
VERY
your GRE
point
if you have
Name
Family
name
First and
Place
InfillAs
general,
mark
for are
to
of
Apr,you
Make
sureatocheck
the
correct
If youspecifying
have
any
learning
experience
or
Research
activities
in Japanese
the
VERY
IMPORTANT
1.
Describe
study
program
inpast
Japan
with
details
VERY IMPORTANT
Photogra
skill,
each
taken. Ifname
not, please leave it a
IMPORTANT
Roman middle
register
as
2016
date,applying
especially
foreducation
columns (In
taken
JLPT,
please
fill
the
above.
If not, please
ph
languages.
describe
with
details
same
asbe
of
above.
Please
fill
in with
block
details.
Charts
will
welcomed.
blank.
Please
carefully
period
International
ofPlease
your
research
“Years
and month
attended”
skip
thisWRITE
part and
go to “Language Proficiency”
DO
NOT
YOUR
capitals)
specify
the oflab should cover Titles, Background for the research, its Issue and Resolution,
years
① Details
universities
and graduated
“Total student.
column.
NATIVE
LANGUAGE.
referring oftoresearch,
How to approach, How unique the research is and its Originality Points.
education”. byPurpose
Unv of Tokyo HP. Date of
Sex
Marital status
Details of your thesis are welcomed.
Male
Female
Single Married
birth
②Explain the
research process
and the
result
obtained
in order and relate with the
description written
in
①
.
Year Month
Day
Age
Nationality
Place of Birth
Present status with the name of your university or employer)
Present contact address
Address
Tel:
Fax :
E-mail :
Contact person in case of emergency
Name Relation:
Address
Tel
Fax
GPA(Grade Point Average)
GRE
General Point
If possible
Bachelor’s
Master’s
Subject Point
(Subject name)
Educational background
Elementa
ry School
Name
Location
School
Name
and
of
Period
attended
to schools
From
Location (City)
To
Middle
School
Name
From
Location (City)
To
High
School
Name
From
Location (City)
To
Universit
y/College
Name
From
Location (City)
To
Years
and
month
attended
Years
Month
s
Years
Months
Major
Subject,
Diploma or Degree
Awarded
Years
Months
Years
Months
4 4-Year University/College
5 5-Year University/College
Graduate
School
Name
From
Location (City)
To
Total years of education
Years
Months
Years
Months
Employment record (Please
chronological order)
Name and address of
organization
Period of employment
From
To
From
To
From
To
fill in your record in
Position held
Type
of work
Academic degree
Institution Year Month
Conferred Degree: a) Bachelor’s Degree
b) Master’s Degree
Doctorial Degree
c)
※
Name of the graduate school, the major and host professor of
the University of Tokyo which you wish to enroll.
Graduate school
Major (Course)
Host Professor
Select one with × in the (
).
( )
Foreign research student (Generally 1 year) + Master course
student (2 years)
Master course student (2 years)
Japanese Language proficiency (If possible)
Period of
Study(MM/YY)
From:
To:
Total study Hours
Proficiency Test)
Date of the test
Month Year
Name of Institution or Course in the
university
Hours
Result of your JLPT (Japanese Language
Place of the test
Your test result
Level passed:
Total score:
Language Proficiency (Except your native
language)
(Evaluate your language level using the
following scale: 4 – Excellent, 3 – Good, 2 – Fair and 1 - Poor.)
Japanese
Englis
h
Others (Specify in
blank)
(
)
Others (Specify in
blank)
(
)
Reading
Writing
Oral
Communicatio
n
If you are applying for
other scholarship, state the details (name of the sponsor,
duration, amount, etc).
I understand and accept all the matters stated in the Application for “Ajinomoto
Scholarship for ASEAN International Students” and hereby apply for this scholarship.
( 「
」
)
Date of application
Applicant’s Signature
Applicant’s name
(In Roman block capitals)
Field of Study and Study Program
Full name (Type or in block letters)
Family name
First name
Research activities in the past
Middle name
Describe study program in Japan with details
Personal statement: Describe about yourself (experience,
why you choose to study in Japan, your future goals, etc) freely and briefly.
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