-
8/11/2019 Specialized 20140704
1/4
APPLICATION FORM
JAPANESE GOVERNMENTMONBUKAGAKUSHO:MEXT) SCHOLARSHIP FOR 2015
Specialized Training College Students
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 building networks after the
student returns home and for sending information by the Japanese
Government when
necessary.
E-mail
Name in full, in your native language (Sex)
Male
(Family name/Surname) (First name) (Middle name) Female
In Roman capital letters LY SENGHUO (Marital Status)
(Family name/Surname) (First name) (Middle name) Single
Write your name exactly as it appears in your passport.)
Married()
-1Nationality -2Possesion of Japanese nationality Yes, I
have
No, I dont have
CAMBODIAN
Date of birth and Age as of April 1,2015( 2015 4 1
1994 June 01 Age 21years 2months
Year Month Day as of April 1, 20152015
Home address and telephone number, facsimile number, E-mail
address
E-mail
Home address(EO 11Z, Street 146, Sangkat Vealvong, Khan 7makara,
Phnom Penh
Telephone/Facsimile number(/FAX(+855)68 341 938
E-mail address [email protected]
If possible, write an E-mail address where you can be contacted
for periods that include the time before you come to Japan, your
stay in Japan and the
period after you return home.E-mail
Preferred field of study and subjects in Japan
Select from the Annex Majors and Related Subjects for Fields of
Study. If you enter a second choice, ensure that it is from the
same field of study as
your first choice.
Fields of study TECHNOLOGY
First choice of subjects Electrical and Electronic
Engineering
Second choice of subjects Computer
Paste your photograph or
digital image taken within
the past 6 months. Write
your name and nationality in
block letters on the back of
the photo.
photo size:4.5 cm x 3.5 cm
((4.5cm3.5cm))
1
,
,
-
8/11/2019 Specialized 20140704
2/4
Field of study you specialized in at high school or
university
Mathematics
Present status (with name of school attending or employer)
Student of Institute of Technology of Cambodia
Student Name of school Institute of Technology of
Cambodia
()
in year 2 grade / will graduate in 2017 September Year Month
Those in employmentName of employer N/A
Educational 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 Preylvea)
Location Takeo)
FromOctober2000
To September2006
6 years
and0 months
Elementary School Diploma
Secondary Education
Lower Secondary School
Name Hengsomrin Preylvea)
Location Takeo)
From October2006
To September2009
3 years
and0 months
Lower Secondary School
Diploma
Upper Secondary School
NameHengsomrin Preylvea)
Location Takeo)
From October2009
To September2012
3 years
and0 months
*-1
Upper Secondary School
Diploma
Higher Education
Undergraduate Level
Name Institute ofTechnology) of Cambodia
LocationPhnom Penh)
From October2012
To April2015
2 years
and6 months
*-2Academic Transcript in
Foundation Year
Total of the years schooling mentioned above
As of April 1, 2015(2015 4 1)
14 yearsand6 months
Notes: Exclude kindergarten education or nursery school
education. ()
Preparatory education for university admission is included in
upper secondary school.
)
If the applicant has passed the qualifying examination for
admission to a university, indicate this in the blank with
*-1.(
-1)
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, skipping
the 3rdyear.)
3
The applicant who has more than one major at his/her university
should list all majors in the blank space with *-2
*-2
Language proficiency:
(1) Evaluate your ability as Excellent", Good", or Poor" in each
blank space.
Reading
Writing
Speaking
Japanese
Poor Poor Poor
English
Good Good Good
Others( French )()
Good Good Good
-
8/11/2019 Specialized 20140704
3/4
10. Japanese language background, if any.()
) Name and address of institution
() N/A
) Period of study
() from to
Year() Month() Year() Month() Years()
11Reasons for choosing to subjects entered in section 5.
Specify reasons for each subjects entered in section 5. Also,
ensure that the subjects in this section are the same as the
subjects entered in section 5.
( )
Subjects and reasons
First choice of subjectsElectrical and Electronic
Engineering
Electrical and Electronic Engineering is my favourite subject. I
feel very happy to work with electricity. When I was a child, I
was the one who could do the electricity network in my home. In
every country, electricity and electronic are the most important
part
of the mordern world. We can not live without them.Also, in
Cambodia, most of the electricity and electronic products are
importedfrom neighboring countries.
Second choice of subjectsComputer
I am really fond of computer technology. I am interested in
math, science and computer. I want to be an engineer who like
to
innovate, to be creative, work in teams, explore how things
work, design new products, and solve problems. Beacause
computers
intergrate into our everyday lives, there is a huge demand of
science technology to satisfy them. I want to help people with
my
knowledge.
12What kind of field are you planning to study in Japan?
()
In Japan, I would like to choose Technology as my field of study
and choose Electrical and Electronics Engineering and Computer
Engineering as my major. The reason is I am good in math and
science. I like to build and analyze things. Also I love locgical
and real
thing. Moreover, my family and my teacher recommend me to study
as well. Even I study science subject I still need to study
others
subjects such as History, English, Japanese ect.
13. What kind of impression do you have of Japan?
I think Japan is one the most advanced country in engineering in
the world. It is such a beautiful country with a lot of great
skyscrapers, bridges and high Towers. It is one of the most
leading country in science technology such as robotics. On the
other hand, I
love their custom and their culture that are different from
Cambodia. I think Japanese people are creative , hardworking and
clever
because they can solve problems related to their daily life such
as natural disaster .
14Description of desired occupation to be taken up after
returning home.
()
When I finish my study in Japan, I will come back to my country.
Then I will work as a good electrician as I wish. I will help
to
develop my country by sharing some good points about Japaneses
culture and some knowledges I learnt in Japan.I hope I can sharemy
skills to all Cambodian people in the near future. I strongly
believe that I can use my capacity to make Cambodias
development
and deal with some problems that always happend in the city.
-
8/11/2019 Specialized 20140704
4/4
15. Person to be notified in applicant's home country, in case
of emergency:
()
Name in full:
SRUN VUOCHMENG
Address with telephone number, facsimile number, E-mail
address
E-mail)
Home Address(Preylvea village, Preylvea commune, Preykabas
district, Takeo province.
Telephone/Facsimile number(/FAX(+855)89 825 136
E-mail address N/A
Occupation:
Farmer
Relationship with the applicant:
Mother
Name(s) of family member(s):
Father() HUK KIMLEANG Occupation() Farmer Nationality()
CAMBODIAN
Mother() SRUN VUOCHMENG Occupation() Farmer Nationality()
CAMBODIAN
16.Immigration Records to JapanBegin with the most recent travel
to Japan N/A
Date Purpose
From
To
From
To
I understand and accept all the matters stated in the
Application Guidelines for Japanese Government
(MONBUKAGAKUSHO:MEXT) Scholarship for 2015,
and hereby apply for this scholarship.
2015
Date of application:
15 June 2014
Applicant's signature:
Applicant's name
in Roman block letters capitals
LY SENGHUO
