BEASISWA KULIAH S2 DI JEPANG OLEH AJINOMOTO SCHOLARSHIP TAHUN 2017 | INDBeasiswa

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APPLICATION FORM

  

FORM

 

 

 

 

 

 

 

 

 

 

1

Ajinomoto Scholarship for ASEAN International Students

・ Type or write in Japanese or in English block letters.  (明 ) に記入すること 瞭

・ Numbers should be Arabic numerals. (数 ) は算用数字を用いること 字

・ Years should be written using the Anno Domini system. ( 年 ) はすべて暦を用いること西 号

・ Proper nouns should be written in full and not abbreviated. (固 ) 名詞は正式名で省略しないこと称 有

Name

(In Roman block capitals)

姓 Family name  名  First and middle name 写 Photograph   真

Paste a passport size

photograph taken within past 6 month. Write your name in block letters on the back of the photo.)

Date of birth

 

       

年     月     日  

  Year   Month        

Day

Sex

 

  Male    

Female

     

男       女  

Marital

status

  Single     

Married

       

未       既婚 婚

Age

Nationality

Place of Birth

 

 

Present status with the name of your university or employer)

   

Present contact address 絡先 連

Address

Tel: Fax :

    Cell Phone:  

E-mail :

Person to contact in case of emergency 連絡先 急

Name  Relation:          

Address

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GPA(Grade Point Average) Bachelor’s Master’s

GRE   General Point 科 Subject Point  識      点 一点般知    目  

( If possible) (Subject name)            

Educational background

Name and Location of School

Period attended to schools

Years and month

attended

Major Subject, Diploma or Degree Awarded

小 校 学

Elementary School

Name

Location (City)

From

To

  Year    

s

        

Months

中 校 学

Middle School

Name

Location (City)

From

To

  Years  

        

Months

高 校

High School

Name

Location (City)

From

To

  Year    

s

        

Months

大 学

University/College

Name

Location (City)

From

To

  Year    

s

        

Months

  4年 4-Year University/College     大学   制

  5年 5-Year University/College     大学   制

大 院 学

Graduate School

Name

Location (City)

From

To

  Year    

s

        

Months

Total years of education   Ye           計年限合 業

ars

        

Months

(3)

組 の名前 織 Name and address of organization

勤 期間 務

Period of employment

役 職

Position

職 種

Type of work From

To From

To From

To

Academic D egree

機 Institution       年 Year                     関      

月 Month  

取 Conferred Degree:   a) Bachelor’s Degree b) Master’s Degree c) Doctorial Degree 学位    得  

          

学  博       士士        修       士

東 す究研院学大る望希るけおに学大科 京

(※希 (入記を名員教導、指)スーコ攻、専科究研院学大学大京東るす。) 望

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

以 Select one with placing × in the ( ). のいずれかをんでください。 選 下

(  ) 外       間(2年す)を希望課る程間士修+)1年則原(生究研人。 国

  Foreign research student (Generally 1 year) + Master course student (2 years)       

( Master course student (2 years)  2。るす望希を)年( 課士修 )  程  

Japanese Language Proficiency  (If possible) 語習熟度  本

日 学 Details of Japanese Language Study 語歴  本 習

学 期間 習

Period of Study(MM/YY)

学 時間 習

Total study Hours

日 語学習機関又は大学履修科目名 本

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From: To: Hours

日 Result of your JLPT (Japanese Language Proficiency Test) 語能力検定試験の結果 本

受 日 験

Date of the test

受 地 験

Place of the test

試 結果 験

Your test result

Month  Year   Level passed:          

Total score:

Language Proficiency (Except your native language) 習熟度(母国語を除く)  学

語 (Evaluate your language level using the following scale: 習熟度を自己価してください評 学

4 – Excellent, 3 – Good, 2 – Fair, 1 - Poor.) Japanese English Others (Specify in

blank)

( )

Others (Specify in blank)

( ) Reading

Writing

Oral

Communication

他 If you are applying for other scholarship, state the 奨の 入記を等額、金関、機前名、そ学合場るいてし募応に金は の

(5)

I understand and accept all the matters stated in the Application for “Ajinomoto

Scholarship for ASEAN International Students” and hereby apply for this

scholarship.

() 「了る事項をすべて承てし、申請します。いれ味プの素スカラシッ」募集要項に記載さ は

申 Date of application 年月日  請

申 Applicant’s Signature 者署名 請

申 Applicant’s name 者氏名  請

Figur

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