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Select a place of examination (Mark )

Bangkok Chiang Mai Khon Kaen Songkla

APPLICATION FORM (THAILAND)

JAPANESE GOVERNMENT (MONBUKAGAKUSHO: MEXT) SCHOLARSHIP FOR 2016

UNDERGRADUATE STUDENTS

Registration No. U

INSTRUCTIONS The application should be typed if possible, or neatly handwritten in block letters. Numbers should be in Arabic numerals. Year should be written using the Anno Domini system. ) Proper nouns should be written in full, and not abbreviated. ) Personal data entered in this application will only be used for scholarship selection purposes, and contact information such as e-mail addresses will

only be used for forming related human networks after the student returns home and for sending of information by the Japanese Government.

E-mail

Name in full, in native language (Sex)

Male

(Family name) (First name) (Middle name) Female

In Roman block letters

(Marital Status)

(Family name) (First name) (Middle name) Single

(Please write your name exactly as it appears in your passport.) Married()

2. Nationality 2-2 Japanese nationality Yes

No

Date of birth(

19 Age

Year Month Day as of April 1, 2016 2016

Present address and telephone number, facsimile number, e-mail address

E-mail

Present address(

Telephone/Facsimile number(/FAX

Mobile ()

E-mail address

If possible, write an e-mail address where we can contact you for periods that include the time before you come to Japan, your stay in Japan and the period

after you return home. E-mail

Chosen field of study in Japan (please check X)

Select from 1.FIELDS OF STUDYin Announcement.

Fields of Study Subjects

U1 Social Sciences and Humanities English, Mathematics (A)

U2

Natural Sciences A English, Mathematics (B), Chemistry, Physics

Natural Sciences B English, Mathematics (B), Chemistry, Biology

Natural Sciences C

6. Chosen majors in Japan (Please complete it all 3 choices within the same Field of Study in page 1 in Announcement Form)

First Choice Second Choice Third Choice

7Would you like to take Japanese Language Test given for evaluation for those who are in the programme of Japanese language

and those who would like to be evaluated their Japanese language skills? Yes No

Paste a passport sized

photograph taken within the

past 6 months. Write your

name and nationality in

block letters on the back of

the photo.

4.5cm3.5cm photo

((4.5cm3.5cm))

2

8Field of study you specialized in at high school or university

9Present status with name of school attending/attended or employer:

Student Name of school ()

in grade / will graduate in Year Month

Those in employmentName of employer

10Educational background:

Name and Address of School

Year and Month

of Entrance and

Completion

Duration of

Attendances

Diploma or Degree awarded,

Major Subject, Skipped years/levels

Elementary Education

()

Elementary School

Name ) Location )

From To

years and months

Secondary Education

Lower Secondary School

Name ) Location )

From To

years and months

Upper Secondary School

Name ) Location )

From To

years and months

*-1

Higher Education

Undergraduate Level

Name ) Location )

From To

years and months

*-2 1) 2)

3)

Total of the years schooling mentioned above

As of April 1, 2016 (2016 4 1)

years and months

Notes: 1. In Thailand, elementary school is for 6 years, lower secondary school is for 3 years, upper secondary school is for 3 years and university is for 4 years.

Those who skipped class, the total years of education are decreased. ( 6 3 3 4

)

2Exclude kindergarten education or nursery school education. ()

3Include preparatory education for university admission in upper secondary school.)

4If the applicant has passed the qualifying examination for admission to a university, indicate this in the blank with *-1.(

-1

5. Any school years or levels skipped should be indicated in the fourth column (Diploma or Degree awarded, Major Subject, Skipped years and levels).

(Example: Graduated high school in two years, etc.)

3

6The applicant who has more than one major at his/her university should list all majors in the blank space with *-2

*-2

G.P.A

3

11Language proficiency:

(1) Evaluate your ability as Excellent", Good", or Poor" in the blank space.

Reading

Writing

Speaking

Japanese

English

Others( )

()

Specify the test results for any English proficiency examinations you may have taken. TOEFL points IELTS points

PTE Academic points TOEIC points Others points ()

Have you ever passed the Japanese Language Proficiency Test? Please Mark either (1) or (2) with a circle. If you marked (1), please state your level.

(1) Yes, I have.

Japanese Language Proficiency Test Level __________

(2) No, I have not.

12. Japanese language background, if any.()

1) Name and address of institution

()

2) Period of study

() from to Total: Years

Year() Month() Year() Month()

13Reasons for choosing to major in the field of study described in item no.6 (page 1). *Specify the reasons for each field of study entered in item no.6. Also, ensure

that the fields of study in this section are the same as the fields of study entered in item no.6

(6 6

Field of study and reasons

First choice

Second choice

Third choice

4

14What kind of field are you planning to study in Japan?

()

15What kind of impression do you have of Japan?

16. Description of desired employment to be taken up after returning home.

()

17.Immigration Records to JapanBegin with the most recent travel to Japan

Date

Purpose

From

To

From

To

18. Person to be notified in applicant's home country, in case of emergency:

()

Name in full:

Address with telephone number, facsimile number, e-mail address

E-mail)

Present Address(

Telephone/Facsimile number(/FAX

E-mail address

Occupation:

Relationship with the applicant:

5

I understand and accept all the matters stated in the Application for Japanese Government (MONBUKAGAKUSHO:MEXT) Scholarship for 2016, and hereby apply

for this scholarship. 2016

Date of application:

Applicant's signature:

Applicant's name

in Roman block letters

( 4 )

1. 1 2. Admission Form ( ) 1 3. Admission Form (4.53.5 cm) 3 4. 1 5. 1 6. 1 ( ) 7. JLPT () 1 8. EJU () 1

* *

**

**

1. 2. 5-15 1 3. (11-12 2558)

2-3 ( 8-12 2558 13.30 -16.30 .)

4. (Fields of Study )