1 Typewritten Or Handwritten in Roman Letters

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INSTRUCTIONS

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1  Typewritten or handwritten in Roman letters

2  Arabic numerals

3  Years in Anno Domini system

4  Proper nouns in full and not abbreviated

PERIOD OF STUDY AT KYUSHU UNIVERSITY (from 3 to 12 months)

From day/month/year to day/month/year

(day / month / year) (day/ month / year)

■PERSONAL DATA

1. Name in full, in Roman block capitals

family name ， first name middle name

(family name) (first name) (middle name)

2. Home University Home University

3．Date of birth etc.

19yy / month / day age Male / Female Single / Married

Year Month Day Age

4. Nationality nationality

5. Present address and telephone number, facsimile number or e-mail address

Number and street number and street

City city State state Zip zip

Country country Telephone / Fax telephone / fax

E-mail E-mail address

(Please fill in your most active E-mail address.)

■FINANCIAL SUPPORT

1．Do you have any other scholarship application in mind ? Yes No

- If yes, give details and expected date of result. Please fill in here

2．Have you received a Japanese scholarship before? Yes No

- If yes, give details. Please fill in here

3．Could you study at Kyushu University without a scholarship? Yes No

- If no, give details. please fill in here

■ACADEMIC DATA

Name and address
of school / Requisite
years of
schooling / Year and month
of entrance and
completion / Period of
schooling / Degree
if
applicable / Major
subject
Secondary
education
Secondary
school / Junior
High Sch / School name
Name of the junior high school graduated from
Location
Location of the school / 0 yrs / From
yy / mm
to
yy / mm / 0 yrs
and
0 mos.
Senior
High Sch / School name
Name of the senior high school graduated from
Location
Location of the school / 0 yrs / from
yy / mm
to
yy / mm / 0 yrs
and
0 mos.
Higher education
Undergraduate level / Univ. name
Name of the university graduated from
Location
Location of the university / 0 yrs / from
yy / mm
to
yy / mm / 0 yrs
and
0 mos. / degree / major
Higher education
Postgraduate level / Univ. name
Name of the University graduated from
Location
Location of the university / 0 yrs / from
yy / mm
to
yy / mm / 0 yrs
and
0 mos. / degree / major
Current school year/grade current year / grade / Total years of schooling 00 years
Expected date of graduation dd / mm / yyyy
Any research to date e.g. thesis title(s)
please fill in the thesis title(s) or short description of research you have been engaged in to date
Awards / accomplishments
please fill in award(s) if you received any / accomplishment to be mentioned particularly

■EMPLOYMENT RECORD： Begin with most recent employment, if applicable.

Name and address of organization / Period of employment / Position / Type of work
name and address of the organization 1 / from: mm / yyyy
to: mm / yyyy / Position name / Type of work
name and address of the organization 2 / from: mm / yyyy
to: mm / yyyy / Position name / Type of work