(7<1JI NOM()-rO® - Multisite ITB

(7<1JI NOM()-rO®

PT AJINOMOTO INDONESIA

JI. Laksda Yos Sudarso No. 7/-78 Sunter.

Jakarta 14350 - Indonesia, P.:J B()x 1019/JKU 14010 Tel . 1021) 6530 4455,6509454

Fax . '021} 651 7282, 651 7275. 653044.13, 6530811 9

Jakarta, December 7

^th,

2012 No. : " ' ISP/AJVXII/2012

Attachments set

To:

~ANDUNG

INSTITUTE OF TECHNOLOGY

Bandung - Indonesia (Attn: Vice Rector - Student Affairs)

Re: AJINOMOTO FOUNDATION SCHOLARSHIP TO UNIVERSITY OF TOKYO Dear Sir,

Refer to Ajinomoto Foundation Scholarship Program for ASEAN Students; we would like to invite your Bachelor students to enter the Selection process to get Scholarship for science major Master Course at University of Tokyo, Japan (www.u-tokvo.ac.jp).

Major for Scholarship are: Engineering, Science, Agriculture & Life Science (except Veterinary Medical Science), Pharmaceutical Science, Frontier Science, Information Science

& Technology, Arts & Science, Mathematical Science, Interdisciplinary Information Science (except Arts course)

The selection process will be started from December 2012 until July 2013 to get one (1) eligible student from Indonesia. Application documents submission dead line in our Jakarta office on:

March lS

^{t \}

2013 .

•

Details of Guidelines, Application Forms and Process are enclosed in the attachment of this letter.

For softcopies of Application form please send email to:csr@ajinomoto.co.id. Thank you for your kind attention.

Acknowledged by, Best Regards,

SHUHEISATO WAHYU DARMAY ANI

Vice President CSR Committee

PT. Ajinomoto Indonesia PT. Ajinomoto Indonesia

---

APPLICATION FORM FORM 1

Ajinomoto Scholarship for ASEAN International Students

r~(J)~A:t.J"3:"":;:1 J $~~iI

•Type orwrite in Japanese or in English block letters.

(BJllltf::~CA"9.Q~c)

-Numbers should be Arabic numerals. (~~fi.m~*~ml, \-@~l:)

-Years should be written using the Anno Domini system. (~iS-li"9"'-c~~m{, \.Q~l:)

-Proper nouns should be written in full and not abbreviated. (1E~:g~ii.lfiJEit:g~-C:-1;i~LtJ:l, \~c)

9,i Family name :g First and middle name

~~~~~--~--.---'r---I

19 ~ FJ D Single· D Married

Year Month *~tJ W~

~~ Photograph Paste a passport size photograph taken within past 6 month. Write your name in block letters on the back of the photo.)

•

Address

Tel:

Fax:

Cell Phone:

E-mail:

Name Relation:

Address Tel

Fax

Bachelor's,_ _ _ _ __ Master's _ _ _ _ __

GRE -"Faa General Point.______ f.:J.§Faa Subject POint"--_ _ _ __

(If possible) (Subject name)

, "

Name and Location of Period attended Years and Major Subject, Diploma or School to schools month attended . Degree Awarded

IJ~ Name From ,, ,, Years

Elementary School ,, ,

Location (City) To Months

, ~

Ef1~ Name From Years

Middle School

Location (City) To Months

, ~

a~ Name From

,,

Years

HighSchool

Location (City) To Months

, ,

~~ Name From , Years

University/College

,,_,,

Location (City) To

,,,

Months

,

D

, ,,

4~*,J~~ 4-Year University/College

D 5~*,J~~ 5-Year University/College

~m Name From

,,, _,

Years

Graduate School

,_,,

Location (City) To

,,

Months

,,,

• • g~1t Total years of education Years Months

N"" ,...-,•• ",""v".'. , ••,-,y~ . , ' .~, .,. ,., . ,.,' ~.., ."

_iEh1pl()~ilt)~ j! ~ftJIIfj] ::}.)~~<t::~{, '(Please fill in your record in chronological order)

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ihftMra' N:1fl 11m

Name and-address of organization Period of employment Position Type of work From

To

From

To

From

To

, ~-

.~

Institution iF Year F.I Month

lttffl-"Tift Confened Degree: a) Bachelor's Degree b) Master's Degree c) Doctorial Degree

~± ~± 1f±

"::,,~.c c,' ",> .~.

Graduate School Major (Course) Host Professor

( ) *1JA.~(JjjlJlIJ1~fm+fJ±R(2~')~*~T-l>o

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

8*RM Japanese Language Proficiency (If possible) B*~g~~Hf Details of Japanese Language Study

"

~m'Mra' ~m'~ra' B*~g~~_XIj:j;:~mi~l4E1 ~

Period ofStudy(MMIYY) Total study Hours Name of Institution or Course in the university

From: To: Hours

B*~gtmt.J~:lE~(J)*6~ Result of your JLPT (Japanese Language Proficiency Test)

~8

,

~±t!! ~j!

Date of the test Place of the test Your test result

Month Year Level passed:

Total score:

•

m~iW~Jl[~ 13 2.~fllliL ""( <t=-~(, '(Evaluate your language level using the following scale:

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

.

( )

Reading

.Others (Specify in blank).

( )

Writing

Oral Communication

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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.

(&f;tr.C1).A1.J7;r~::fJ"'lif::~tL"CL \.Qqt:T~"c7~l.. .. $Rl..U 0)

$a~~~ B Date of application

$~~~¥~ Applicanfs Signalue

$~~~f£~ Applicanfs name

(In Roman block capitals)

'.

Family name First name Middle name

,

r:.,.

.,

Describe about yourself (experience, why you choose to study in Japan, your future goals, etc) free and briefly.eH:N1),::c(f*Il.. 8~I::.il

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8

Applicanfs name (in print):

Family name First name Middle name

To·the Recommender:

This person named above is applying for "Ajinomoto Scholarship". We would appreciate if you gave us your opinion of the applicanfs academic abilities, together with some comments on hisJher dlaracter and potential that helshe would be leading the future Asia and oontribute to the friendship between hislher oounby and Japan. Please fill in the below questions and write your reoommendation in English or in Japanese. In order to ensure oonfidentiaiity. please place this in an. envelope, sign the seal and return to the applicant We welcome early submission to the candidate. Thank you for your oooperation and would like to assure you that your oomrnents will carefully be oonsidered.

How long have you known the applicant? From._ _ _ _ _ To._ _ _ _ __

In what capacity? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Please identify the group to whiCh you are comparing the applicant

8 Undergraduate students D Master's level students

Others (Please identify the specific group): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

How many years, approximately. have you evaluated people in this group? _ _ _ _ _ _ __

How many people are in the group, in round numbers, totaled over those years? _ _ _ _ _ _ __

Please rate the applicant ralative to others in the group:

Exceptional Excellent Very Good Good Average Poor NlA Top 2% Top 5% Top 10% Top 25% 50% Below 50%

Academic Perfonnances

D D D D D D D

Intellectual Potential

D D D D D D D

Interpersonal skills

D D D D D D D

Creativity and Originality

D D D D D D D

Motivation for Graduate Studies

D D D D D D D

Reasons for Recommendation

---

---

,

,

Please give us your con1act infonnation:

Name of Recommender:

Post or Position Institution Address:

E-mail: TEL:

FAX: '---­

s~~~

__________________________

Date:

Appendix 1

Application details of each graduate school of the University of Tokyo (Science courses, except medicine and veterinary medicine)

o Applicants may apply either from Research Student or Master's course for Graduate School of Engineering, Information Science and Technology, Frontier Science, and Science. [NOTE]Applicants for Graduate School of Science may only apply when obtaining required

GRE subject test score. •

o Applicants may apply only from Research Student for Graduate School of Pharmaceutical Science and Agricultural and Life Science.

o Applicants may apply only from master's course for Graduate School of Mathematical Science and Information, Technology an~

Society in Asia Course, Interdisciplinary Information Studies(IT ASIA), ITASIA is a program in English and may enroll from Oct.

o Graduate School of Science, Engineering, Agricultural and Life Science and Frontier Science have special Program in English. Confirm the details for applying In University of Tokyo website.

@Refer the following chart

,--­

Graduate schools Science Pharmaceutical Engineering Information Agricultural and Interdisciplinary Frontier Science Mathematical

Science Science and Life Science Information Studies Science

Technology (lTASIA)

Enrollment to Research Student course

+ 0 0 0 0 0 X 0 X

Master's course Enrollment course

to master's

0 X 0 0 X 0 0 0

. Enrollment in Oct only

--~--~

<.J

a

11

Appendix 2

(j)Graduate School Application for International Research Students (prescribed form) And 3 photos (4 cm * 3 cm)

®Summary of Research plan (prescribed form)

@Plan of Student life in Japan induding your financial plan (prescribed form )

..

@AII diplomas or graduation certificates issued by

universities or colleges attended

*English Version is preferred

@Transcript of scholastic record issued by all universities or colleges attended.

"English Version is preferred.

@A letter of recommendation from the Chairman or Faculty Advisor of the universities or colleges attended in English or in Japanese, issued within 6 months of the deadline.

\L)Certificate of proficiency in Japanese language written by a Japanese instructor

(prescribed form or Japanese level certificate)

~clence

Agricultural and Life Science

(Excluding . rveterinary Medical

·Applicants to the Department of Astronomy mus submit GRE (Graduate Record Examination score

reports

of the Subject Test (P.77-Physics). .

• Applicants to the Department of Earth an~

Planetary Science must submit GRE score report~

of the Subject Test (anyone of the subjects) and TOEFL score reports. .

• Applicants to the Department of Biophysics 8 Biochemistry should submit GRE score reports fo the Subject Test (B22-Biochemistry, Cell and Molecular Biology or B24-Biology). AppUcant~

interested in Bioinformatics and Systems Biolog~

may submit the score of M6S: Mathematics, C29 Computer Science or P77: Physics instead of the

•

above subjects.

@Certificate of health issued within 3 months of the deadline

(prescribed tonn or Health check Certificate)

@Contact Fonn (prescribed tonn)

<Required Documents>.

(])Application for Admission as a Graduate Intematlonal Research Student (Fonn provided)

~Confinnation of degree or graduation certificate i$Sued by the university or college

attended (must be original).

@Transcript of academic record issued by the university or college attended (must be original).

@Letter of recommendation from the President, the Dean, the Chainnan, or major professor (academic advisor) ofthe university or college attended.

@Study Program (Form provided)

®Statement of balance of your bank account (only required for Self-Supported Students) Q)Financial Plan Questionnaire(Form provided, only required for Self-Supported StUdents)

Notes:

Please attach a Japanese or English translation issued by the university it the document is not written in either of these languages.

<Required Documents>

(])Graduate School Application for International Research Students (prescribed fonn)

~AII diplomas or graduation certificates issued by

~ciences)

universities or colleges attended.

@Transcripts of scholastic record issued by all universities or colleges attended.

@Recommendation from the President, Dean, Department Chairman or Faculty Advisor.

@Certificate of proficiency in Japanese Language (from a language teacher or equivalent)

(prescribed form)

@Study Program as an International Research

Student (prescribed form)

(!)The student ID card form (Attach a color photograph 4cm x 3em) (prescribed form)

Pharmaceutical •

<Required Documents>

~cience

Q)Application Form for Admission

(prescribed form)

®

Photographs: Three identical photographs (4

, em x 3cm) taken within the last three months. One

of Three photographs must be attached to the designated area on the application form.

Photographs should be upper body face shots of the applicant without any head covering

@Transcripts of Degree issued by the university and the graduate school attended

@Transcript of Scholastic Record issued by the university and the graduate school attended

*GPA, its grading system and numbers of credits should be attached

@Recommendation from the President, Dean, Chairman or the academic supervisor of the

graduate school attended

®Certificate of Proficiency in the Japanese Language: a copy of Certificate of Japanese Language Proficiency Test(JLPT) or a certificate approved by the applicant's instructor or equivalent authority (prescribed form) (£)TOEFL Score Certificate (TOEFL scores are valid if the tests were taken two years before the date of the application

@Health Certificate (prescribed form)

®Study Program (prescribed form)

@)Financial Plan (prescribed form)

•

@Bank Statement (as of application date)

@Transaction Report (report for 3 months before application)

-

*1. In case of the applicant is to provide his/her

living expenses by scholarship, scholarship documents are necessary of 11), 12) .

. <Required Documents>

(Except Arts

Q)Application form. an extra applicant photo (size

course)

3 x 4 em) must be clipped. (Assigned form)

®Transcripts of academic records certifying the grades of undergraduate coursework and master's coursework

@AII Diplomas or graduation certificates issued by universities or colleges you have attended.

Frontier Science

IS

@Comments from Expected Supervisor at the

GSFS (Assigned form)

@StudyPlan (Assigned form)

@Financial Plan (Assigned form)

<L)Certificate of Japanese Proficiency (Assigned form)

@Certificate of Physical Check up

(Assigned form)

.

@Contact sheet (Assigned form)

nformation

<Required Documents>

~cience

and

Q)Official Application for Admission as a

lTechnology

Postgraduate International Research Student form

~Official Statement of Research Plan form

@Official graduation certificate issued directly by the university or college attended

@Official transcript of scholastic record issued directly by the university or college attended

@Letter of recommendation either from the department chairman or the faculty advisor of the university or college attended, either in Japanese or in English. This must be signed and dated within six months prior to the application deadline (the last day of the applicable period of application)

@Official Certificate of Proficiency in Japanese form to be filled out by a teacher of the Japanese language, or a similarly qualified person, signed and dated within six months prior to the application deadline.

(i)Official Certificate of Health form to be

completed. signed. and dated within three months prior to the application deadline

@Official Plan of Student Life in Japan form

Additional documents required by the department to which applicant is applying

,.,athematical

Apply directly to a graduate school master's

~clence

course. (international research students are not accepted.)

nterdlsclplinary

Apply directly to a graduate school master's

nformation

course (international research students are not

Studies

accepted.)

(lTASIA)

• Please refer HP. etc, of each graduate schools for the latest assigned documents before applying .

• Please prepare the necessary document. such as TOEFL Official Score Report. according to the above list.

·The scores of TOEFL. GMAT. and GRE should be within the limited period assigned by each Graduate Schools. For detailed inf<,?rmation. please inquire directly to each Graduate Schools.

APPLICATION FORM

Ajinomoto Scholarship forASEAN International StudeniS

r~~~Aji7~:I:tl$~.

-Please type or \Mite in .1apalese or in &Ig&sh block letters.

<Ulf::taA T

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-tbnbers should be AnDc runeraIs. (1r-F1~ml.

\QU:>

-y~should be written usqthehnJ Domini system (~"lI;tt~"C~.IfiI. \Q~C) -Proper I'lOI.IlS should be witten in U nnot abbreviated.

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As

cI

Apr, 2013

Address

Tel:

Fax:

E-mail:

Name Relation:

Address

Tel

BacheIor's._ _ _ __ Master's _ _ _ __

GRE

~General Point'--____

ff§JIa

&.qectPoint'--_ _ __

(If possilIe) (SI.t!iect name)'--_ _ _ _ _- - ­

Write your GRE point if you

have Iaken.1f

not,

please leave

it

a blank.

Make sure

to

fil the correct

date,

especialy

for coIurms

"Years

and

month

attended"

and

"To1aI ye8rs d

education".

~

Place a check mark

for

applying education

period

of

your

graduated universities

Name IIld Location Period attended

y~

II1d inoOth

~~ ~

or

ciSchool tQSchooIs •..8ttended . ..•

~;6.~

IJ~ Name

From

^Y~

Elementary

School I..ocaIion (City)

To

Months

~ Name

From

^Y~

Midde

School I..ocaIion (City)

To

Months

~ Name

From

^Y~

High School

I..ocaIion (City)

To

Months

~ Name

From

^Y~

~

University/C

allege Location (City)

To

Months

4 ~ltt~ 4-Year University/College

5 ~ltt~ 5-Year University/College

From

Years

location (City)

To

Y~

Months

M,.

^(J)

:g lliI

Name IIld adaess ci

MMIIII &ft

Position held

_Type

org;rization Period cief11lioyment afWCllk

From

To

From

To

From

To

referring to Unv

of

Tok)oHP.

_ Institution

~ Yese

J'I

Month

'-¥E-'-'<Jq=<',=,~,--~ nMitL Conferred~

a) Bachelor' s

Desree

b) Master' s Degree c) DoctoriaI Dewee

!'f!± tJ± ff±

IIltRf·

In

genetaI,

you are to ) fHIA~(1Ql1g) +~(2~HfIT.Qo

-

register as International

FcnitrI

~sbJdent (Generaly 1 )'U') + Master

course

student

C2

yea-s)

research

student ⁽ ) tiR(2~)~*~T.Qo Mastercxusestudent(2years)

B~g~fSJ!Jl Japanese Language proficiency

(If

possible)

B*m!!F~1I

ftJUJIIII

~ 13~~B_XI;t:;t;:~.

PeriodrK Total study t-brs _tJt~El4S

Study(MM/YY) Name rK Institution or Ccx.rse i1 the LIliYersity

From: To: Hotn

B*mtmi.J~~iit.(])Mm

^Result

of

your JLPT (Japanese language Proficiency Test)

HI3 B*

~

Date ofthe test

/

Place rK the test Y01.1" test resUt

Marth

Yese!

Level passed:

Total score:

/

I( you have atrf

Japanese learning

experience or taken

JLPT,

please fiB the above. If not,

please

skip this part

and go

to

"language Proficiency" column.

t!~1li~f3{~

§ 2.a.iil.;("

<t=~\,

'<Evaluate your language lev.el using the foHowing scale: 4 - Excellent, 3 - Good, 2 - Fair and 1 - Poor.)

.J8pII1eSe

Engish OtherS· (Speclynblank>

Others (Specify

n

bIId)

( ) ( )

Reacing

~ Please fill ycu

^larvage

..Jnll,

specifying each

Writing

- ---::::::::: languages.

nn

NOT WRITE YOUR

Oral Comnulication

NATIVE LANGUAGE

it!!0)~~~/::J;t.L.

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-t-(1)~

iUJ, 11M,

~g~~lcA

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 ..Aiinomoto Scholarship for ASEAN International Students" and hereby apply for this scholarship.

(fA/;j:r,*(1)~A:t.J"7~';t:1J.Ul1i/::~n"("\' \{)$l1i~-t~"("7~L., EfltftL.*-t 0) Efl~~~ B Date of application

EflM.~ Applicant's Signature

Efl!H~~

ApprlCant' s name

(In Roman block capitals)

2\

Family name First name Middle name

~*~Ifj,fgI~~~~il'I:~·PBst

It~1l _ _ .jt._~f;;" .. :VERYS1MPORTjij11

Please fill in with details. Charts will be welcomed.

(])Details should cover Titles, Background for the research, its Issue and Resolution, Purpose of research, How to approach, How unique the research is and its Originality Points. Details of your thesis are welcomed.

h.·~6&stUdYpj-Ograni in Japan with details veRY IMPORTANll

Please describe with details same as of above.

8~. PE!r$drial~ment: Desaibe about yourself (experience, why you choose to study in Japan, your future goals, etc) freely and briefly.

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