INSTRUCTIONS

This application must be written in either Japanese or English.

Numbers should be in Arabic numerals.
Years should be written using the Anno Domini system.()
Proper nouns should be written in full and not abbreviated.()
For the scholarship payment period, write the period from April 2016 (or October, etc.) until the end of the standard course
duration of the course of study in which you intend to enroll.2016410

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 information
by the Japanese Government.
E-mail

1 Name in full In Roman capital letters (Please write your name exactly as it appears in your passport).

Sex ()
,
( )
(Family Name) (First Name) (Middle Name)

Marital Status
2 Nationality ()

( )
3 Date of birth ( )

19 / /
Year Month Day Age(as of April 1,2016)201641

4
Present address

Telephone number Email address

Email

If possible, write an email 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

5 Name of university in which you are enrolled at the time of application

Name of faculty/graduate school

Name of major

University year

Expected month and year of admission/graduation (completion)

 Month and year of admission
Month and year of (expected) graduation

/ /

Year Month Year Month

Academic adviser
6 Intended university of attendance and period of scholarship payment

(1) First choice

Name of university

Name of graduate school

period of scholarship payment

2016 / /
Total Months
Year Month Year Month

(or Month) (or Month)

(2) Second choice

Name of university

Name of graduate school

period of scholarship payment

2016 / /
Total Months
Year Month Year Month

(or Month) (or Month)

7 Thesis title
bachelor's/master's/doctoralN.B. Choose the (most recent) applicable
thesis. ( )

Write down the most recent thesis such as your bachelor's thesis if you are a four-year undergraduate student intending to
advance to a master's, your master's thesis if you are enrolled in a master's course and you have decided on the title of your
master's thesis and your bachelor's thesis if you have not yet decided on the title of your master's thesis. 4

8 Family status (write only the family members presently with you in Japan)

Name Relationship Age Occupation Living together, living separately

9 Status of income (reference) (In cases of living with a spouse and family members, add the total income.)
<>

Average monthly income yen

() (excluding MEXT scholarships)

[Breakdown]

(1) Amount of financial assistance

Monthly yen
from your family
amount ()

(2) Part-time work

Monthly yen

amount ()

(3) Other forms of income

Monthly yen Contents:

amount ()

10 Status of expenditure (Reference) (In cases of living with a spouse and family members, add the total expenditure.)
<>

Average monthly expenditure yen

() (including MEXT scholarships)

[Breakdown]

(e.g., study supplies, laboratory expenses,

(1) Study and research expenses
Monthly yen materials expenses, outside activities,

amount () etc.)

(2) Housing expenses

Monthly yen

amount () types

of housing
( )

(3) Food expenses

Monthly yen

amount ()

(4) Transportation expenses

Monthly yen

amount ()

(4) Other expenditure

Monthly yen Contents:

amount ()

11 Research plan or research status

For the research plan of your intended graduate school, create a "research plan or research status sheet" either in Japanese or
English.

I understand and accept all the matters stated in the Application for the extension of the scholarship payment period for Japanese
Government ScholarshipResearch Students, and hereby apply for the extension of the scholarship payment period.

Date of application: ()

Applicant's namein Roman letters
capitals)()


304076

19 error error error error

#N/A

0 E-mail 0

error

2016 20

2016 20

0 0

INSTRUCTIONS

This application must be written in either Japanese or English.

Numbers should be in Arabic numerals.
Years should be written using the Anno Domini system.()
Proper nouns should be written in full and not abbreviated.()
For the scholarship payment period, write the period from April 2016 (or October, etc.) until the end of the standard course duration
of the course of study in which you intend to enroll.2016410

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 information by the
Japanese Government.E-mail



In R
1 Name in full In Roman capital letters (Please write your name exactly as it appears in your passport).

Sex ()

, Pul
( female )
(Family Name) (First Name) (Middle Name)
Marital Status
2 Nationality ()

( married ) Pull
3 Date of birth
19 81 / 1 / 1 ( 34 ) R

Year Month Day Age(as of April 1,2016)201641

4
Present address --

Telephone number 00-0000-0000 Email address xxx@xx.xx.xx
Email

If possible, write an email 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

5 Name of university in which you are enrolled at the time of application

Name of faculty/graduate school

Name of major

University year

Non-degree student, etc. (non-regular student)

Expected month and year of admission/graduation (completion)

2014.4

For Non
please f
current
(e.g.: 20


Month and year of admission 2014.4
Month and year of (expected) graduation

2014 / 10 2016 / 3
For Non
please f
Year Month Year Month current
(e.g.: 20
Academic adviser
6 Intended university of attendance and period of scholarship payment

(1) First choice

Name of university

A

M
Name of graduate school Plea
(MA,
AMA to en
period of scholarship payment

2016 / 4 2018 / 3 24
Total Months

Year Month Year Month

(or 10 Month) (or 9 Month)
Please d
(2) Second choice
you are a
from Fall
Name of university

Name of graduate school

period of scholarship payment

2016 / /
Total Months
Year Month Year Month

(or Month) (or Month)

7 Thesis title
bachelor's/master's/doctoralN.B. Choose the (most recent) applicable
thesis. ( Bachelor )

Write down the most recent thesis such as your bachelor's thesis if you are a four-year undergraduate student intending to advance to
a master's, your master's thesis if you are enrolled in a master's course and you have decided on the title of your master's thesis and
your bachelor's thesis if you have not yet decided on the title of your master's thesis. 4

8 Family status (write only the family members presently with you in Japan)


Only th
Name Relationship Age Occupation Living together, living separately present

33
9 Status of income (reference) (In cases of living with a spouse and family members, add the total income.)
<>

if you d
Average monthly income 50000 yen instead
() (excluding MEXT scholarships)

[Breakdown]

(1) Amount of financial assistance

Monthly 50000 yen
from your family
amount ()

(2) Part-time work

Monthly yen
amount ()

(3) Other forms of income

Monthly yen Contents:
amount ()

10 Status of expenditure (Reference) (In cases of living with a spouse and family members, add the total expenditure.)
<>
=Bre
Average monthly expenditure 140000 yen
() (including MEXT scholarships)

[Breakdown]

(e.g., study supplies, laboratory expenses,

(1) Study and research expenses
Monthly 50000 yen materials expenses, outside activities,
amount () etc.)
Pu
(2) Housing expenses A
Monthly 30000 yen types of housing

amount () ( Dormitory

)

(3) Food expenses

Monthly 20000 yen
amount ()

(4) Transportation expenses

Monthly 20000 yen
amount ()

(4) Other expenditure Contents:

Monthly 20000 yen
amount ()

11 Research plan or research status

For the research plan of your intended graduate school, create a "research plan or research status sheet" either in Japanese or English.

I understand and accept all the matters stated in the Application for the extension of the scholarship payment period for Japanese
Government ScholarshipResearch Students, and hereby apply for the extension of the scholarship payment period.


I

Date of application: () 2014 12 1

Applicant's namein Roman letters

capitals)()


304076

1- 2 / 5

000000

19 81 1 1 35

401

--

00-0000-0000 E-mail xxx@xx.xx.xx Pu D

T

Pu

A A

Pu
Do
2016 4 20 18 3 24
10 9

2016 20

 Recommendation and Report Letter
The gray cells will be filled in automatically. You do not need to fill it in.

Name of university Univ. No. 304076 Leave Blan

Reason for Leave Bla

Classification the extension /
Name MEXT NO. Choo
Date of Birth 19 Sex

Nationality Country No.
Present address in
Japan
Telephone number E-mail

Field of Field of Engin
Field of Recearch and
Research Major
Field of Major of the
Graduate School you Scie
plan to enter My Research is about


bachelor's/master'
s/doctoral Thesis
Thesis title
title

Name of current Univ. Name of

graduate
Current Enrollment Title of Current Major school
Information
(In Japanese) Name of Current CurrentEnr
Supervisor ollmentYear
Program No.
First choice
Name of NameOfGrad
university uate School

Name of University
major year
2016 20

Name of
University which Academic (Fill in if possible)
you intend to attend Adviser
in 2016
Second choice
/
Period of Name of NameOfGrad
scholarship university uate School
payment Name of University
(In Japanese) major year
Tot
From 2016 (month) to 20 (year) (month) al months
(or from (month) or to (month))
Name of
Academic (Fill in if possible)
Adviser

Leave Blan

Leave B

Leave
Research Papers
Published(Presente
d), Excellent
Performance(Ex:
Patents or Awards
obtained)etc.
 Research Papers
Published(Presente
d), Excellent
Performance(Ex:
Patents or Awards
obtained)etc.
< Guidelines of Application Form>

1. Read the instructions thoroughly, and fill in all items.

2. Use half-width characters for numbers, half-width upper-case letters for Roman letters, and full-width chara

3. Your age as of April 1, 2016 will be calculated automatically based on what you write in for your birth date.
If the automatic calculation does not work properly, write in your age as of April 1, 2016. Page

4. In the column "Expected month and year of admission/graduation (completion)" of item 5 in page 1,
please fill in the year and month of the admission and the graduation (completion) of your current course.
For non-degree research students, please fill in the start and end of your current scholarship period.
If you forgot it, please contact the CIE office.
(2 years for April admission, 1.5 years for September admission. e.g.: 2013.4-2015.3, 2013.9-2015.3)

5. In the column "Name of Graduate School" of item 6 in Page2,

please also specify the course (MA, Professional Degree (MBA) or PhD) that you intend to enter
after the name of graduate school. ( e.g. Waseda Business School (MBA))

6. In the column "Period of Scholarship Payment" of item 6 in Page2,

"Total Months" for scholarship payment is calculated automatically based on what you write in for "period of
If the automatic calculation does not work properly, manually fill in the correct information in "Total Months.
If there is a possibility that you will enter the next course from Spring or Fall semester,
please fill in "from April to March" in the upper line, and "from October to September"
(For those who enter the next course from Fall semester, the new scholarship period starts from October in
in the lower line. (Standard course term: Two years for MA and Professional degree (MBA), Three years for

7. In the column "Average monthly income" of item 9 in Page3, if you dont have any monthly income, please

8. "Recommendation and Report Letter" in Page 4 is only in Japanese. Please refer to the Sheet "English Sam
to confirm the columns you must fill in.
Please fill in your "MEXT Number," "Country Code," "Field of Major" and "Field of Research" of the graduat
and "Current Enrollment Information" in page 4. Please leave your MEXT number in blank if you forgot it; C
You can find your "Country Code" in the second sheet (Date (University, country etc.)).

9. For "Field of Research" of the graduate school you wish to enter, please choose from the pull-down menu.
For "Field of Major" and "My Research is About," please input directly.
In the "Current Enrollment Information" column, please input the same information you filled in for the first s
There is no need to fill any information in the "Program Number" column.

10. Regarding the items below, please choose the applicable answer from the pull-down menu. If the pull-dow
please refer to the "Pull Down Reference" and choose the applicable answer from the "Date (University, C
copy and paste it into the column.
"Sex" and "Martial status," Page1
"University year"Page12
"Degree" of thesis titlePage2
"type of housing"Page3
an letters, and full-width characters for Katakana.

ou write in for your birth date.

ril 1, 2016. Page

n)" of item 5 in page 1,

etion) of your current course.
ent scholarship period.

4-2015.3, 2013.9-2015.3)

t you intend to enter

what you write in for "period of scholarship payment."

t information in "Total Months."

p period starts from October instead of September)

degree (MBA), Three years for PhD degree)

e any monthly income, please fill in "0" instead of leaving it blank.

refer to the Sheet "English Sample"

d of Research" of the graduate school you wish to enter

mber in blank if you forgot it; CIE will input it on your behalf.

ose from the pull-down menu.

ation you filled in for the first sheet.

ull-down menu. If the pull-down menu does not display correctly,

r from the "Date (University, Country, etc.)" and


1.

2.

3.201641
2016411

4.15

21.52014.42016.32014.92016.3

5. 26
MBA

6.26

43
109910
23

7.390

8. 4

Data(University, Country etc.)

9.

10.
Pull Down ReferenceData(University, Country, etc.)






101001 101 60 2000 2002 2014 1971

101002 102 61 2001 2003 2015 1972
101003 103 62 2002 2004 2016 1973
101004 104 63 2003 2005 2017 1974
101005 105 64 2004 2006 2018 1975
101006 106 65 2005 2007 2019 1976
101007 107 66 2006 2008 2020 1977
102001 108 67 2007 2009 2021 1978
102002 109 68 2008 2010 2022 1979
102003 110 69 2009 2011 2023 1980
102004 111 70 2010 2012 1981
102005 112 71 2011 2013 1982
102006 113 72 2012 2014 1983
102007 114 73 2013 2015 1984
103001 115 74 2014 2016 1985
103002 116 75 2015 2017 1986
103003 117 76 2016 2018 1987
103004 118 77 2017 2019 1988
103005 119 78 2018 2020 1989
103006 120 79 2019 2021 1990
103007 121 80 2020 2022 1991
103008 171 81 1992
103009 172 82 1993
103010 190 83 1994
103011 201 84 1995
103014 202 85 1996
103015 204 86 1997
103016 205 87 1998
104001 206 88 1999
104002 207 89 2000
104003 208 90 2001
104004 209 91 2002
104005 210 92 2003
104006 211 93 2004
104008 212 94 2005
104009 213 95 2006
104012 214 96 2007
104013 215 97 2008
104014 216 98 2009
104015 251 99 2010
105001 290 2011
105002 301 2012
105003 302 2013
105004 303 2014
105005 304 2015
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105007 306 2017
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302010 774


302011 775
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302013 790
302014 801
302015
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309051
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2 _ _

01 14 male single Fourth-year undergraduate

02 15 female married Non-degree student, etc. (non-regular student)
03 16 First-year of master's course(first half of doctor's course)
04 17 Second-year of master's course(first half of doctor's course)
05 18 First-year of professional degree course
06 19 Second year of professional degree course
07 20
08 21
09 22
10 23
11 24
12 25
13 26
14 27
15 28
16


_ _ _ _

1 Bachelor 1 1 Dormitory
1 Master 2 2 Lodgings
1 1 Doctor 3 3 Rented house
2 4 4 Other
1 5 5
2 6 6
7 7
8 8
9 9
10 10
11 11
12 12
13
14
15
16
17
18
19
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INSTRUCTIONS

This application must be written in either Japanese or English.

Numbers should be in Arabic numerals.
Years should be written using the Anno Domini system.()
Proper nouns should be written in full and not abbreviated.()
For the scholarship payment period, write the period from April 2016 (or October, etc.) until the end of the standard course
duration of the course of study in which you intend to enroll.2016410

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 information
by the Japanese Government.
E-mail

1 Name in full In Roman capital letters (Please write your name exactly as it appears in your passport).

Sex ()
,
( Q )
(Family Name) (First Name) (Middle Name)

Marital Status
2 Nationality ()

( R )
3 Date of birth ( )

19 / /
Year Month Day Age(as of April 1,2015)201541

4
Present address

Telephone number Email address

Email

If possible, write an email 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

5 Name of university in which you are enrolled at the time of application

Name of faculty/graduate school

Name of major

University year

Expected month and year of admission/graduation (completion)

 Month and year of admission
Month and year of (expected) graduation

/ /

Year Month Year Month

Academic adviser
6 Intended university of attendance and period of scholarship payment

(1) First choice

Name of university

Name of graduate school

period of scholarship payment

2016 / /
Total Months
Year Month Year Month

(or Month) (or Month)

(2) Second choice

Name of university

Name of graduate school

period of scholarship payment

2016 / /
Total Months
Year Month Year Month

(or Month) (or Month)

7 Thesis title
bachelor's/master's/doctoralN.B. Choose the (most recent) applicable
thesis. ( Z )

Write down the most recent thesis such as your bachelor's thesis if you are a four-year undergraduate student intending to
advance to a master's, your master's thesis if you are enrolled in a master's course and you have decided on the title of your
master's thesis and your bachelor's thesis if you have not yet decided on the title of your master's thesis. 4

8 Family status (write only the family members presently with you in Japan)

Name Relationship Age Occupation Living together, living separately

9 Status of income (reference) (In cases of living with a spouse and family members, add the total income.)
<>

Average monthly income yen

() (excluding MEXT scholarships)

[Breakdown]

(1) Amount of financial assistance

Monthly yen
from your family
amount ()

(2) Part-time work

Monthly yen

amount ()

(3) Other forms of income

Monthly yen Contents:

amount ()

10 Status of expenditure (Reference) (In cases of living with a spouse and family members, add the total expenditure.)
<>

Average monthly expenditure yen

() (including MEXT scholarships)

[Breakdown]

(e.g., study supplies, laboratory expenses,

(1) Study and research expenses
Monthly yen materials expenses, outside activities,

amount () etc.)

(2) Housing expenses

Monthly yen

amount () types

of housing
( AD )

(3) Food expenses

Monthly yen

amount ()

(4) Transportation expenses

Monthly yen

amount ()

(4) Other expenditure

Monthly yen Contents:

amount ()

11 Research plan or research status

For the research plan of your intended graduate school, create a "research plan or research status sheet" either in Japanese or
English.

I understand and accept all the matters stated in the Application for the extension of the scholarship payment period for Japanese
Government ScholarshipResearch Students, and hereby apply for the extension of the scholarship payment period.

Date of application: ()

Applicant's namein Roman letters
capitals)()


#N/A

AF /

19 error error error error

#N/A

0 E-mail 0

error

2016 20

2016 20

AA

#N/A

0 0