2013日本政府(文部科学省)奖学金申请书

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1、A AP PP PL LI IC CA AT TI IO ONN F FO OR R J JA AP PA ANNE ES SE E G GO OV VE ER RNNMME ENNT T ( (MMO ONNB BUUK KA AG GA AK KUUS SHHO O: :MM ) ) S SC CHHO OL LA AR RS SHHI IP P日本政府(文部科学省) 奨学金留学生申請書Research Students for 2013(研究留学生)(記入上注意)The application should be typed if possible, or neatly handwrit

2、ten in block letters. (明瞭記入)Numbers should be in Arabic numerals.(数字算用数字用)Years should be written using the Anno Domini system. (年号西暦)Proper nouns should be written in full and not abbreviated. (固有名詞正式名称,一切省略)* Personal data entered in this application will only be used for scholarship selection pur

3、poses, and contact information such as e-mail addresseswill only be used for forming related human networks after the student returns home and for sending information by the Japanese Government.(本申請書記載個人情報,本奨学金選考使用,特 E-mail 等連絡先,帰国後関係者作及必要応日本政府各種情報送信以外使用。 )(Sex)Name in full in your native languageMa

4、le(男)(姓名(自国語) (Family name/Surname) (First name) (Middle name)Female(女)In Roman block capitals(Marital Status)(字) (Family name/Surname) (First name) (Middle name)Single(未婚)Married(既婚)Nationality 2-2Japanese nationality Yes ()(国 籍) (日本国籍有者)No()Date of birth(生年月日) 19Year(年) Month(月) Day(日) Age (as of

5、April 1,2012)(年齢 2012 年月日現在)Present status with the name of the university attending or employer(現職(在籍大学名又勤務先名記入) )Present address and telephone number, facsimile number, E-mail address(現住所及電話番号,番号,E-mail )Present address(現住所)Telephone/facsimile number(電話番号/FAX 番号)E-mail address* If possible, write

6、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.(可能限、渡日前日本留学中帰国後使続予想 E-mail 記入。 )Field of specialization studied in the past(Be as detailed and specific as possible.)(過去専攻専門分野(具体的詳細書) ),P

7、aste 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)(写真(4.5cm3.5cm)Educational background (学歴)Name and Address of School(学校名及所在地)Year and Month of Entrance and Completion (入学及卒業年月)Amount of time

8、spent at the school attended (修学年数)Diploma or Degree awarded, Major subject(学位資格,専攻科目)Elementary Education (初等教育)Elementary School (小学校)Name(学校名)Location(所在地)From(入学)To(卒業)years(年)andmonths(月)Secondary Education (中等教育)Lower Secondary School (中学)Name(学校名)Location(所在地)From(入学)To(卒業)years(年)andmonths(月

9、)Upper Secondary School (高校)Name(学校名)Location(所在地)From(入学)To(卒業)years(年)andmonths(月)Higher Education (高等教育)Undergraduate Level (大学)Name(学校名)Location(所在地)From(入学)To(卒業)years(年)andmonths(月)*-1Graduate Level (大学院)Name(学校名)Location(所在地)From(入学)To(卒業)years(年)andmonths(月)Total years of schooling mentioned

10、 above (以上通算全学校教育修学年数) As of April 1,2012 (2012 年月日現在)Years and months(年) (月)* If the blank spaces above are not sufficient for the information required, please attach a separate sheet(注) 上欄書場合,適当別紙記入添付)Notes: Exclude kindergarten education or nursery school education. (幼稚園保育所教育含)Include preparatory

11、 education for university admission in secondary education.(大学予備教育中等教育含)If the applicant has passed the university entrance qualification examination, indicate this in the blank with *-1.(大学入学資格試験合格場合,旨-1 欄記入)State the titles or subjects of books or papers (including graduation thesis authored by th

12、e applicant), if any, with the name and address of the publisher and the date of publication.(著書,論文(卒業論文含)題名,出版社名,出版年月日,出版場所記)Please write the title of your graduation thesis or project paper.* Please attach abstracts of those papers to this application.((注)論文概要添付)Employment record: Begin with the m

13、ost recent employment excluding the part-time job.(職歴:除。 )Name and address of organization(勤務先及所在地)Period of employment(勤務期間)Position(役職名)Type of work(職務内容)FromToFromTo10Japanese language proficiency: Evaluate your level and insert an X where appropriate in the following blank space.(日本語能力自己評価,該当欄印記

14、入)Excellent (優)Good (良)Fair (可)Poor (不可)Reading (読能力)Writing (書能力)Speaking (話能力)11Foreign language proficiency: Evaluate your level and insert an X where appropriate in the following blank space.(外国語能力自己評価,該当欄印記入)Excellent (優)Good (良)Fair (可)Poor (不可)English (英語)French (仏語)German (独語)Spanish (西語)12The first course you plan to take in Japan(日本最初入学希望課程)Please mark either ), ), ) or ) with a circle.(希望最初入学希望課程次選択,。 )) Research student(研究生)) Masters degree course(修士課程)) Doctoral course(博士課程)) Professional graduate course(専門職学位課程)13Proposed period of study(希望渡日時期)Please mark eithe

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