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PL ACE M E NT PRE FE RE N CE F O RM FO R JA PAN E SE GOVE RN ME N T (MO N BU KAGA KU SHO :M E XT ) SCH OL AR SH IP

Research Students for 5

Name in full in Roman capital letters


Paste your photograph

(Sex)

or digital image taken

(Family name/Surname)

Male

(First name)

(Middle name)

withinthe past 6

Femalemonths.

Write your name and


nationality in block

Date of birth and Age as of April 1,2015( 2015 4 1

letters on the back of


the photo.

19
Year

Month Day

(as of April 1,2015) 2015

photo size:4.53.5

Nationality

Home address, telephone and facsimile number, e-mail address where you can be contacted.

E-mail

The institution you have graduated/will graduate.

Institution

Conferred Degree
( )

a) Bachelors Degree
( )

Year

b) Masters Degree

( )

Month

c) Doctoral Degree

( )

Field of study in Japan

Detailed field of study

The university in Japan in which you wish to enrolled.


The course you plan to take in Japan in the first place
Please mark either a), b), c) or d) with a circle.
a) Research student(non-regular student)

b) Regular Student for a Master's degree course


c) Regular Student for a Doctoral course
d) Regular Student for a Professional graduate course
Enter the names of the universities in which you would like to enroll and state whether you have obtained Admission from
them. If you have not gained admission, please explain the reasons in full. (No more than three universities.) Do not, enter the
name of universities you have already been rejected . MEXT will request your admission only to the universities listed below.
3

Name of University

Name of Professor

* MEXT will consider your preference, but it may not be met because of university enrollment capacity. Therefore, please
note in advance that placement in preferred universities, especially in Tokyo, Kyoto and Osaka, is not guaranteed.
(

Term you wish to study in Japan


Please mark either a), b), c) or d) with a circle.
a) Only a research students term (two years or one year and six months)
b) Until completion of the masters degree course
c) Until completion of the doctoral course

d) Until completion of the professional graduate course

If you are applying for other scholarships, state the name of the sponsor, duration, amount, etc.
)

Have you been awarded a Japanese Government (Monbukagakusho:MEXT) Scholarship in the past? If so, please give the period,
the name of the university, etc.

)
) Yes, I have.

) No, I have not.

Period:

Type:

University: