No.
Year 2016-2017
HIF FOREIGN SCHOLARS FELLOWSHIP APPLICATION FORM
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Nothing may be attached or affixed to the application form.
Degrees and Educational Background
12
Name of Degree(s)
Major Field
Date Received
(Month,Year) Institution,
City, Country
Period of Attendance
From-To (Month,Year) Doctoral
Received: Expected Completion:
Attach a
Photo taken within
the last 6 months
6
4.0 × 3.0 (cm) Full Name
1
(in Native Language)
(surname)
(first) (middle) Full Name
2
(in Romanized & Katakana Letters)
Romanized
(surname)
(first) (middle)
Katakana (if possible)
(surname)
(first) (middle) Date of Birth
Year Month Day
Age
2015 4 (As of April 1, 2015)
Nationality
Native Language
Marital Status
Married Single
Mailing Address Must be valid as of Dec. 2015
Address *
Please write clearly and accurately as this is the address we will send the selection result to.
City Zip Code Country
E-mail: Tel: Fax: Permanent Address
Address
□
← Check here if the information is same as the above mailing addressCity Zip Code Country
E-mail: Tel: Fax: Name of Organization
and Present Title
10
Name of Organization
Present Title Address of Organization
11
Address
City Zip Code Country
E-mail: Tel: Fax: Please Type or Print in Ink (Script is not acceptable).
Bachelor
Received:
No.
Year 2016-2017
Employment History13
Starting with the most recent one. Employer
Address (City, Country)
Period
Title and Description of Work
Awards
14.
Organization
Address (City, Country)
Name
Year
Major Publication (Up to 3 publications such as books and theses. Please put title, journal, publisher, date, number of pages, and keywords.)
15
3
*Please fill in (1) with the publication considered most significant in your academic career.
(1)
(2)
(3)
Summary of Present Research
16
Topic Title
Description
No.
Year 2016-2017
Proposed Research and Research Plan at Hosei University
17
Topic Title
Description in Detail (Present research related to research plan, Purpose of proposed research, Proposed research plan, Expected results and impact)
No.
Year 2016-2017
Proposed Hosei faculty research advisor and reason for this choice (this item must be filled in)
18
（（（（（（（（
Name of research advisor his/her faculty
:
Reason
Relationship to this individual and previous contact if any (check the appropriate box/es).
19
□
□
Have had previous contact prior to this application
□
Have looked into the individual’s research interests by reading
□
his/her thesis/dissertation/ papers/articles
□
Hosei University home page
□
his/her individual home page
□
other
□
Personally acquainted with the individual via
□
/
Past or present joint research
□
Meeting(s) at a conference/symposium
□
other
□
Have no real personal acquaintance with this individual but
□
/
Have conducted/am conducting joint research via mail
□
Have been introduced by a third party (e.g., by individual/s involved in joint research with you)
□
Have made contact for the purpose of this application
□
Other
Advantage of Doing this Research at Hosei University
20
Proposed Length of Stay at Hosei University
From October, 2016 to year month
2016 10
Months
No.
Year 2016-2017
Language Proficiency: Japanese/English (Check the appropriate column)
22
/
Japanese
English
Excellent
Average
Low
None
Excellent
Average
Low
None
Reading
Writing
Speaking/Listening
Previous experiences in Japan
23
Starting with the most recent one. Period (From mm/yyyy to mm/yyyy)
Place
Purpose (If scholarship recipient, name of scholarship)
(
)
Recommendations (refer to Guidelines, p. 7, nos. 4, 5)
24
p3, nos. 4, 5
Recommendations
Name
Institution,Position
Head of the Institution
(Rec-1)
Research Supervisor/ Instructor
(Rec-2)
Name(s) and term(s) of any other scholarship(s)/loan(s) you are now receiving:
25
Name(s) of any other scholarship(s)/loan(s) you are now applying for:
26
How did you learn about HIF program. (Check one or more)
27
HIF
(
○
)
Hosei University publications or web site Your own institution
3
Other
I certify that the above statement is true and correct to the best of my knowledge.
Date Signature
