Master's Degree and Internship Program of African Business Education Initiative For Youth (ABE Initiative) 5th Batch

ABE Initiative 5th Batch
CONFIDENTIAL
1-(1) Application Form
Master's Degree and Internship Program of African Business Education Initiative for Youth
(ABE Initiative) 5th Batch
APPLICATION FORM
Reg.No
Instruction
1. Handwritten form is not acceptable
2. Fill in the form in English
3. It is a MUST to fill all the YELLOW columns (Please write "N/A" if not applicable)
4. Write years in western calendar
5. Write proper nouns in full without abbreviation
6. Sign all pages on the bottom of right-hand corner after printing
7. Check your application form using the check list at the bottom of this application form
1. Personal Information
1-1. Title
Master's Degree and Internship Program of African Business Education Initiative for Youth (ABE
Initiative) Color Photo
(4cm3cm)
1-2. Number (Not need to fill in. JICA will inform after selection Procedures) Paste your photo
taken within
6 months.
J
1-3. Information about the applicant
Family Name
First Name
Other Name
(If any)
Date of Birth
Sex (Day/Month/Year)
/ /
Age
Nationality
(As of 1/4/2018)
Religion
Resident Country
(if any)
TEL
City/Town
(Primary)
TEL
State/Province
(Secondary)
Passport
Email
possession
1-4. Contact Person in Emergency
Name Relationship
Province &
TEL Email
Country
Name of Applicant:
Signature:
1
CONFIDENTIAL
2. Declaration of desired university placement
1) All applicants are required to specify first, second and third choice of Universities, and Supervisors of choices by reference to "2-(2):
University Information for the Applicants" and ABE Initiative Portal Website.
(http://www.education-japan.org/africa/search/)
Name of Selected University and

Priority Course Code Program and Degree Supervisor of choice
Graduate School
2) Please select the item number of your reseach field. Refer to "Research Field" sheet for more detail
Item
Research Field
Number
3) If disqualified by the universities of first, second and the third-choice at the 3rd selection,
JICA might choose the other appropriate universities for you.
Do you grant JICA the authority to choose other university for you?
Name of Applicant:
Signature:
2
CONFIDENTIAL
3. Educational Background
Instruction
1Exclude kindergarden education and nursery school education.
2Preparatory education for university admission is included in upper secondary education.
3If you attended multiple schools at the same level of education due to moving house or readmission to university,
modify level column and write the schools in the separate rows.
4Any school years or levels skipped or repeated should be indicated in the Remarks column.
5. End date for Higher Education should match with the date on the guraduate certificate which you submit.
6. Academic Degree must be filled for Higher Education level. (If not obtained any degree, write "N/A")
Name of School Province, Years of From (Month)/(Year)

Level Academic Degree
Faculty / Department Country schooling To (Month)/(Year)
From /
Primary
Education
To /
From /
Lower Secondary
Education
To /
From /
Upper Secondary
Education
To /
From /
Higher Education
To /
From /
To /
From /
To /
From /
To /
Total Years of Education: 0 years of schooling
Please write the reasons in "Remarks" if you need to make a supplement or explanation for the instruction 4, 5, or 6,.
Remarks
Name of Applicant:
Signature:
3
CONFIDENTIAL
1) Language Proficiency
Excellent: Refined fluency skills and topic-controlled
Listening discussions, debates & presentations. Formulates
strategies to deal with various essay types, including
narrative, comparison, cause-effect & argumentative
Speaking essays.
Good: Conversational accuracy & fluency in a wide range of

English Reading situations: discussions, short presentations &
Proficiency interviews. Compound complex sentences. Extended
essay formation.
Writing
Fair: Broader range of language related to expressing
opinions, giving advice, making suggestions. Limited
Certificate compound and complex sentences & expanded
(if any) paragraph formation.
ex. TOEFL, IELTS
Poor: Simple conversation level, such as self-introduction,
Mother Tongue brief question & answer using the present and past
ex. French tenses.
Other Language
(if any)
Proficiency of the other language
2) Have you ever been awarded a scholarship for studying abroad?
Name of scholarship
Duration From / To /
3) Are you currently applying for any scholarship(s), other than ABE Initiative?
Name of scholarship
4) Have you ever participated in any training course in your country or abroad including any offered by JICA?
Name of the course
Name of the institution or

Country you visited
agency
Duration From / To /
Name of Applicant:
Signature:
4
CONFIDENTIAL
4. Present Organization and Nomination
4-1. Present Organization and Position
Type of Organization* if others, specify
Organization
Department / Division
Position
Date of assignment to the

Date of employment / / / /
present position
Province &
TEL Email
Country
Cateory of Organization Type of Organization Description

A. Private Sector Private Private company including Private school
National Government Ministry or Federal Institution
B. Ministry /
Local Government Governmental Institution run by state/province or city/town
Government Institution
Public Enterprise Government-owned corporation or facilities
C. Higher Education
University Either public or Private University
and TVET
NGO/Private(non-profit) NGO or non-profit organization
Self-employed Freelancer (if you own a company, chose "Private")
D. Others Fresh Graduate Just graduated or will Graduate soon from University and not working
Unemployed not working

Others Any status not applying to all above
4-2. Confirmation of the nomination by the applicant's present organization
I agree to nominate this person on behalf of our organization
Date Signature
Name
Department / Division
Position
Official Stamp
TEL
Email
Name of Applicant:
Signature:
5. Work Experience
Provide the information of your work experience following the most recent one.
The first row (most recent one) will be filled automatically if 4-1 is correctly filled.
Period of Full/
Organization Department Position From / To Type
Working Part
From /
5
CONFIDENTIAL
From /
To Oct / 2017
From /
To /
From /
To /
From /
To /
From /
To /
From /
To /
From /
To /
**For the type of organization, please choose from the followings:
A. Private Sector B. Ministry / Government Institution

C. Higher Education and TVET (Technical and Vocational Education and Training) Institutions
D. Others (non-profit organization etc.)
*Please refer to Category of Organization on page 5 (4. Present Organization and Nomination)
Total years of full-time job experience: 0 year and 0 month

Total years of part-time job experience: 0 year and 0 month
Name of Applicant:
Signature:
6. Medical History
6-1. Present Medical Status

a) Do you currently use any medicine or have regular medical checkup by a physician for your illness?
Name of illness, and condition
Name of medicine
If yes, please attach your doctor's letter (preferably, written in English) that describes current status of your illness and agreement to
join the program
b) Are you pregnant?
Months of pregnancy month Expected date of delivery /
6
CONFIDENTIAL
c) Are you allegic to any medication or food?
What are you allegic to?
d) Please indicate any needs arising from disabilities that might necessitate additional support or facilities.
Note: Disability does not lead to exclusion of persons with disability from the program. However, upon the situation, you may be
directly inquired by the JICA official in charge for a more detailed account of your condition.
6-2. Past Medical History

a) Have you had any significant or serious illness?
if yes, please specify
b) Have you ever been a patient in a mental clinic or been treated by a psychiatrist?
if yes, please specify
6-3. Other Medical Problems

If you have any medical problems that are not described above, please indicate below.
Name of Applicant:
Signature:
7
CONFIDENTIAL
7. Declaration
I, ,
declare that I apply for the Masters Degree and Internship Program of African Business Education Initiative for Youth (ABE Initiative) with a full understanding of the
General Information for ABE Initiative, especially the articles stipulated below:
(1) APPLICATION
1. all the information answered and provided in this application form by me, is true and accurate to the best of my knowledge and
ability. My application will be cancelled if any information is proven to be false.
2. all the information provided by me in this application form had been approved by my supervisor in my organization
(Required only for Governmental Officials (including public organizations) and/or Educators.)
3. an application form which is incomplete or missing any necessary document(s) will be deemed ineligible and not considered.
4. the selection procedure and results rest entirely with JICA as the secretariat of ABE Initiative. No inquiries or objections by
applicants regarding the result of the selection process will be considered.
(2) OBJECTIVE OF THE PROGRAM

When I am accepted for the program, I agree
1. that the objective of the program which is written in G.I. Therefore, I will participate in observation tours of companies, summer
internship, and post graduate internship as designated by JICA,
2. that I am required to contribute to the development of my nations relationship with Japan after completing the Masters course and
Internship in Japan,
3. that the objective of the program is not provision of employment in Japan upon completion of the program.
(3) JICAs GUIDELINES

When I am accepted for the program, I agree
1. to invite my family (spouse and children only) on my own responsibilities for all expenses and necessary procedures after
6 months upon arrival in Japan to follow JICAs Guidelines,
2. all the information answered in 8. MEDICAL HISTORY is true, and to accept that medical conditions resulting from an undisclosed
pre- existing condition may not be financially compensated by JICA and may result in termination of the program,
3. to carry out such instructions and abide by such conditions as may be stipulated by both the nominating government and the
Japanese Government regarding the program,
4. to follow the program, and abide by the rules of the institution or establishment that implements the program,
5. to refrain from engaging in political activity or any form of employment for profit or gain,
6. to return to my home country at the end of the activities in Japan on the designated flight schedule arranged by JICA,
7. to discontinue the program if JICA and the applicatns current organizations agree on any reason for such discontinuation and
not to claim any cost or damage due to the said discontinuation,
8. to consent to waive exercise of my copyright holders rights for documents or products that are produced during the course of the
program, against duplication and/or translation by JICA, as long as they are used for the purposes of the program,
9. to approve the privacy policy and the copyright policy in the G.I.
JICAs Information Security Policy in relation to Personal Information Protection
JICA will properly and safely manage personal information collected through this application form in accordance with JICAs
privacy policy and the relevant laws of Japan concerning protection of personal information and take protection measures to
prevent divulgation, loss or damages of such personal information. Any information able to identify individuals that is acquired
from applicants/participants shall be entered into and stored in Portal Website, used or analysed within the scope of ABE Initiative
Programs and activities of concerned parties: JICA, JICE, Japanese Universities and registered Japanese enterprises.
Unless otherwise obtained approval from an applicant itself or there are valid reasons such as disclosure under laws and
ordinances, etc., and except for the following 1.-3., JICA will neither provide nor disclose personal information to any third party.
JICA will use personal information provided only for the purposes in the following 1.-3 and will not use for any purpose other than
the following 1.-3 without prior approval of an applicant itself.
1. To provide ABE initiative to the participants.
2. To provide ABE initiative to the participants from developing countries under the Citizens Cooperation Activities.
3. In addition to 1. and 2. above, if the government of Japan or JICA determines necessary in the course of technical
cooperation.
10. to observe Japanese laws and ordinances (including, for example, such as Sexual Harassment) during my stay, if I violate,
will return the total amount or a part of the expenditure required for ABE Initiative depending on the extent of the violation,
11. to understand that JICA does not assure issuance of Japan entry visa even after JICA decide to accept me.
I understand the Embassy of Japan will decide it according to necessary formalities upon the submission of visa application
from each participant.
Name of Applicant:
Signature:
DATE (Day / Month / Year): / /
8
CONFIDENTIAL
Check List
Please check the following BEFORE printing

Page Check Point Applicant JICA JICE HQ
All Are all the Yellow columns (MANDATORY) filled?
Is the full name written as shown on the Passport?

(National ID is acceptable if the applicant does not own a Passport)
1
Is the date of birth same as on the Passport or ID?
Is your age between 22 to 39? (if not, check qualified age at JICA overseas office in charge of your country)
2 Is the name of supervisors chosen from the professor list in the ABE Initiative portal website?
Is the schooling years corresponded to the years specified in University Diploma and Academic Transcript?
Is the name of the degree same as in the "University Diploma" and "Academic Transcript"?
3
Is the total schooling years over minimum academic years for Bachelor's degree? your total schooling years-> 0 years
If the schooling years does not match with the regular academic period, is it explained in the Remarks column?
4 Is the applicant appying for any scholarship other than ABE Initiative?
5 Is the name of organization, department, and position correctly mentioned? (No abbreviation is allowed)
Is the working history and period correctly filled?

6 Any employment before university completion is not considered as working history.
Only full-time working with acquisition of diploma, such as night school, is approved as working experience.
Is the research plan written with enough amount of words?

Annex 3 (Extreme lack of words may not be accepted)
Research Plan
Is the "Title", "Introduction", "Objective" and "Conclusion", respectively followed?
Please check the following AFTER printing

All Is there a signature on the bottom-right corner of all pages?

1 Is the applicant's photo attached on the Application form?
5 Is there official stamp/signature of current organization?
8 In the Declaration Form, is the signed date within the application period?
Is the notary seal* affixed to University Diploma?

The copied document of original one is approved only with the original notary seal affixed.
*The notary seal: To officially notarize the copied document, affixed by authorized public institutions or lawyers.
University Diploma
Is the name and date of birth as shown on the Passport or ID? If not, please describe the reason in the letter.
If not written in English, is the official English translation attached?

Is the notary seal affixed to Academic Transcript for all the grades earned in the university?
Academic Transcript Is the name and date of birth as shown on the Passport or ID? If not, please describe the reason in the letter.
If not written in English, is the official English translation attached?
Recommendation
Letter Is there original Recommendation letter attached?
Copy of Is the copy of valid Passport (or National ID) attached?

Passport(ID) If not written in English, French, Portuguese or Spanish, is the official English translation attached?
Photos Is 6 photos attached other than attaching on page 1 of Application Form?
If yes in 6-1(a), is the doctor's letter (written in English) attached? The letter should describe current status of the
(Doctor's Letter)
applicant's illness and has a consent for an applicant to join the program healthy.
Please check the following BEFORE submission

All Are all attachments submitted?
Reg.No Name of Applicant:
9
Category Area
Integrated Disciplines Informatics
Integrated Disciplines Environmental science

Integrated Disciplines Complex systems

Humanities and Social
Humanities/ Social sciences
Sciences
Humanities/ Social sciences
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Interdisciplinary science and
Science and Engineering
engineering
engineering
engineering
engineering
engineering
engineering
engineering
engineering
engineering
engineering
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engineering
engineering
engineering
Science and Engineering Mathematical and physical sciences

Science and Engineering Chemistry
Science and Engineering Engineering


Biological Sciences Biological Sciences
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Biological Sciences Agricultural sciences

Biological Sciences Medicine, dentistry, and pharmacy



Discipline
Principles of Informatics
Human informatics
Human informatics
Human informatics
Human informatics
Human informatics
Human informatics
Human informatics
Frontiers of informatics
Environmental analyses and evaluation
Environmental conservation
Sustainable and environmental system
development
development
development
Design science
Human life science
Human life science
Human life science
Science education/ Educational technology
Science education/ Educational technology
Sociology/History of science and technology
Cultural assets study and museology
Geography
Social/Safety system science
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Biomedical engineering
Health/Sports science
Childhood science
Biomolecular science
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Brain sciences
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Area studies
Gender
Philosophy
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law
law
law
law
law
law
law
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Management
Management
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Sociology
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Psychology
Psychology
Psychology
Psychology
Education
Education
Education
Education
Nano/Micro science
Nano/Micro science
Nano/Micro science
Nano/Micro science
Nano/Micro science
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Applied physics
Applied physics
Applied physics
Applied physics
Applied physics
Applied physics
Quantum beam science
Computational science
Mathematics
Mathematics
Mathematics
Mathematics
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Astronomy
Physics
Physics
Physics
Physics
Physics
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Earth and planetary science
Plasma science
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Basic chemistry
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Materials chemistry
Materials chemistry
Materials chemistry
Materials chemistry
Mechanical engineering
Electrical and electronic engineering
Civil engineering
Civil engineering
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Architecture and building engineering
Material engineering
Process/Chemical engineering
Integrated engineering
Neuroscience
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Laboratory animal science
Oncology
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Genome science
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Biological Science
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Basic biology
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Anthropology
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Plant production and environmental agriculture
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Applied aquatic science
Applied aquatic science
Agricultural science in society and economy
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Agro-engineering
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Animal life science
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Boundary agriculture
Pharmacy
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Basic medicine
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Society medicine
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Clinical internal medicine
Clinical surgery
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Clinical surgery
Clinical surgery
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Clinical surgery
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Clinical surgery
Dentistry
Dentistry
Dentistry
Dentistry
Dentistry
Dentistry
Dentistry
Dentistry
Dentistry
Dentistry
Nursing
Nursing
Nursing
Nursing
Nursing
Research Field
Theory of informatics
Mathematical informatics
Statistical science
Computer system
Software
Information network
Multimedia database
High performance computing
Information security
Cognitive science
Perceptual information
processing
Human interface and interaction
Intelligent informatics
Soft computing
Intelligent robotics
Kansei informatics
Life / Health / Medical informatics
Web informatics, Service informatics
Library and information science/ Humanistic social informatics
Learning support system
Entertainment and game informatics
Environmental dynamic analysis
Risk sciences of radiation and chemicals
Environmental impact assessment
Environmental engineering and reduction of environmental burden
Modeling and technologies for environmental conservation and remediation

Environmental conscious materials and recycle
Environmental risk control and evaluation
Environmental and ecological symbiosis
Design and evaluation of sustainable and environmental conscious system
Environmental policy and social systems
Design science
Home economics/Human life
Clothing life/Dwelling life
Eating habits
Science education
Educational technology
Sociology/History of science and technology
Cultural assets study and museology
Geography
Social systems engineering/ Safety system
Natural disaster / Disaster prevention science
Biomedical engineering/ Biomaterial science and engineering
Medical systems
Medical engineering assessment
Rehabilitation science/ Welfare engineering
Developmental mechanisms and the body works
Sports science
Applied health science
Childhood science (childhood environment science)
Biomolecular chemistry
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Brain biometrics
Area studies
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Philosophy/Ethics
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Nanostructural chemistry
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Nanomaterials chemistry
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Nano/Microsystems
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Algebra
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Basic analysis
Mathematical analysis
Foundations of mathematics/Applied mathematics
Astronomy
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Condensed matter physics I
Condensed matter physics II
Mathematical physics/ Fundamental condensed matter physics
Atomic/Molecular/Quantum electronics
Biological physics/Chemical physics/Soft matter physics
Solid earth and planetary physics
Meteorology/Physical oceanography/Hydrology
Space and upper atmospheric physics
Geology
Stratigraphy/Paleontology
Petrology/Mineralogy/ Economic geology
Geochemistry/Cosmochemistry
Plasma science
Physical chemistry
Organic chemistry
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Functional solid state chemistry
Synthetic chemistry
Polymer chemistry
Analytical chemistry
Bio-related chemistry
Green/Environmental chemistry
Energy-related chemistry
Organic and hybrid materials
Polymer/Textile materials
Inorganic industrial materials
Device related chemistry
Materials/ Mechanics of materials
Production engineering/ Processing studies
Design engineering/ Machine functional elements/ Tribology
Fluid engineering
Thermal engineering
Dynamics/Control
Intelligent mechanics/ Mechanical systems
Power engineering/Power conversion/Electric machinery
Electronic materials/ Electric materials
Electron device/ Electronic equipment
Communication/ Network engineering
Measurement engineering
Control engineering/System engineering
Civil engineering materials/ Construction/ Construction management

Structural engineering/ Earthquake engineering/ Maintenance management
engineering
Geotechnical engineering
Hydraulic engineering
Civil engineering project/ Traffic engineering
Civil and environmental engineering
Building structures/Materials
Architectural environment/ Equipment
Town planning/ Architectural planning
Architectural history/Design
Physical properties of metals/Metal-base materials
Inorganic materials/Physical properties
Composite materials/Surface and interface engineering
Structural/Functional materials
Material processing/Microstructural control engineering
Metal making/Resorce production engineering
Properties in chemical engineering process/Transfer operation/Unit operation
Reaction engineering/Process system

Catalyst/Resource chemical process
Biofunction/Bioprocess
Aerospace engineering
Naval and maritime engineering
Earth system and resources engineering
Nuclear fusion studies
Nuclear engineering
Energy engineering
Neurophysiology / General neuroscience
Nerve anatomy/Neuropathology
Neurochemistry/ Neuropharmacology
Laboratory animal science
Tumor biology
Tumor diagnostics
Tumor therapeutics
Genome biology
Medical genome science
System genome science
Conservation of biological resources
Molecular biology
Structural biochemistry
Functional biochemistry
Biophysics
Cell biology
Developmental biology
Plant molecular biology/Plant physiology
Morphology/Structure
Animal physiology/Animal behavior
Genetics/Chromosome dynamics
Evolutionary biology
Biodiversity/Systematics
Ecology/Environment
Physical anthropology
Applied anthropology
Science in genetics and breeding
Crop production science
Horticultural science
Plant protection science
Plant nutrition/Soil science
Applied microbiology
Applied biochemistry
Bioorganic chemistry
Food science
Forest science
Wood science
Aquatic bioproduction science
Aquatic life science
Agricultural science in management and economy
Agricultural science in rural society and development
Rural environmental engineering/Planning
Agricultural environmental engineering/Agricultural information engineering
Animal production science
Veterinary medical science
Integrative animal science

Insect science
Environmental agriculture(including landscape science)
Applied molecular and cellular biology
Chemical pharmacy
Physical pharmacy
Biological pharmacy
Pharmacology in pharmacy
Natural medicines
Drug development chemistry
Environmental and hygienic pharmacy
Medical pharmacy
General anatomy (including histology/embryology)
General physiology
Environmental physiology (including physical medicine and nutritional physiology)
General pharmacology
General medical chemistry
Pathological medical chemistry
Human genetics
Human pathology
Experimental pathology
Parasitology (including sanitary zoology)
Bacteriology (including mycology)
Virology
Immunology
Medical sociology
Applied pharmacology
Laboratory medicine
Pain science
Epidemiology and preventive medicine
Hygiene and public health
Medical and hospital management
Legal medicine
General internal medicine (including psychosomatic medicine)
Gastroenterology
Cardiovascular medicine
Respiratory organ internal medicine
Kidney internal medicine
Neurology
Metabolomics
Endocrinology
Hematology
Collagenous pathology/ Allergology
Infectious disease medicine
Pediatrics
Embryonic/Neonatal medicine
Dermatology
Psychiatric science
Radiation science
General surgery
Digestive surgery
Cardiovascular surgery
Respiratory surgery
Neurosurgery
Orthopaedic surgery
Anesthesiology
Urology
Obstetrics and gynecology
Otorhinolaryngology
Ophthalmology
Pediatric surgery
Plastic surgery
Emergency medicine
Morphological basic dentistry
Functional basic dentistry
Pathobiological dentistry/ Dental radiology
Conservative dentistry
Prosthodontics/ Dental materials science and engineering
Dental engineering/ Regenerative dentistry
Surgical dentistry
Orthodontics/Pediatric dentistry
Periodontology
Social dentistry
Fundamental nursing
Clinical nursing
Lifelong developmental nursing
Gerontological nursing
Community health nursing

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Master's Degree and Internship Program of African Business Education Initiative For Youth (ABE Initiative) 5th Batch

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Master's Degree and Internship Program of African Business Education Initiative For Youth (ABE Initiative) 5th Batch

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ABE Initiative 5th Batch

1-3. Information about the applicant

1-4. Contact Person in Emergency

2. Declaration of desired university placement

Name of Selected University and

Name of School Province, Years of From (Month)/(Year)

Total Years of Education: 0 years of schooling

Good: Conversational accuracy & fluency in a wide range of

Proficiency of the other language

2) Have you ever been awarded a scholarship for studying abroad?

Name of the course

Name of the institution or

4. Present Organization and Nomination

4-1. Present Organization and Position

Type of Organization* if others, specify

Date of assignment to the

Cateory of Organization Type of Organization Description

Unemployed not working

4-2. Confirmation of the nomination by the applicant's present organization

I agree to nominate this person on behalf of our organization

**For the type of organization, please choose from the followings:

A. Private Sector B. Ministry / Government Institution

Total years of full-time job experience: 0 year and 0 month

6-1. Present Medical Status

Name of illness, and condition

b) Are you pregnant?

Months of pregnancy month Expected date of delivery /

c) Are you allegic to any medication or food?

What are you allegic to?

6-2. Past Medical History

if yes, please specify

if yes, please specify

6-3. Other Medical Problems

(2) OBJECTIVE OF THE PROGRAM

(3) JICAs GUIDELINES

DATE (Day / Month / Year): / /

Please check the following BEFORE printing

All Are all the Yellow columns (MANDATORY) filled?

Is the full name written as shown on the Passport?

Is the working history and period correctly filled?

Is the research plan written with enough amount of words?

Please check the following AFTER printing

All Is there a signature on the bottom-right corner of all pages?

Is the notary seal* affixed to University Diploma?

If not written in English, is the official English translation attached?

Copy of Is the copy of valid Passport (or National ID) attached?

Please check the following BEFORE submission

All Are all attachments submitted?

Reg.No Name of Applicant:

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