Application Form [UNDERGRADUATE 2010]

Social Science Natural Science A (Physics)

/ Natural Science B (Biology)

APPLICATION FOR JAPANESE GOVERNMENT (MONBUKAGAKUSHO) SCHOLARSHIP 2010 Undergraduate Students

INSTRUCTIONS 1. The application should be typewritten if possible, or neatly hand-written in block letters. 2. Numbers should be in Arabic figures. 3. Year should be written in the Anno Domini system. 4. Proper nouns should be written in full, and not abbreviated. 5. Use our format to help to speed-up the short-listing process.

1. Name in full, in native language ___ ____,___________,__________

(Family name) (First name) (Middle name)

(Sex) Male Female

In Roman block capitals ______KOH______,__MING_____ ,_____JUN (Family name) (First name) Nationality MALAYSIAN______________ (Middle name)

(Marital Status)

Single Married

2.2 Japanese nationality Yes No

3.

Date of birth

1991________________02___________21___________18____ (Year) (Month) (Day) (Age)

4. Present status with the name of the school attended, or of employer STUDENT OF SEKOLAH MENENGAH (P) SULTAN ABU

BAKAR_________________________________ 5. Present address and telephone number, facsimile number, e-mail address ADDRESS: 51, JALAN MAS JAYA (2), TAMAN MAS JAYA, JALAN SALLEH , 84000 MUAR, JOHOR. TELEPHONE NUMBER: 012-6388603 EMAIL ADDRESS:sashakoh@hotmail.com

6. Chosen field of study in Japan First Priority Second Priority Third Priority MEDICINE BIOTECHNOLOGY NURSING

7. Field of study specialized in the past at your high school or university CHEMISTRY AND BIOLOGY__ 8. Education background Name and Address of School Year Month Entrance and Completion Name Elementary Education Elementary School SJK(C)CHUNG HWA PRESBYTERIAN To Location JALAN HASHIM,84000 MUAR, JOHOR. Name SM(P)SULTAN BAKAR To Location
Secondary School
P.S 58 JALAN ABDUL SCIENCE

and of

Period schooling attended

of

Certificate/ Degree

Major subject

From 05/01/1998 6 yrs and 0 mths

UPSR

BAHASA MELAYU

ENGLISH

07/11/2003

CHINESE

Secondary Education

Lower

From ABU 05/01/2004 3 yrs and 0 mths

PMR

BAHASA MELAYU

ENGLISH

20/11/2006

MATHEMATICS

RAHMAN, 84000 MUAR, JOHOR.

Upper

Name SM(P)SULTAN BAKAR Location

P.S 58 JALAN ABDUL

From ABU 02/01/2007 To 31/12/2008 0 mths 2 yrs and

SPM
*-1 _

ENGLISH

BIOLOGY

CHEMISTRY

RAHMAN, 84000 MUAR, JOHOR.

PHYSICS

BAHASA MELAYU

*-2 Higher Education Undergraduate Level Name _ Location _ To _ _ mths 3)_______ Total years of schooling as 11 yrs and 0 Notes: i. ii. iii. iv. v. Exclude kindergarten education, nursery school education or remove classes (for secondary school education). Include preparatory education for university admission in secondary education. If the applicant has passed the qualifying examination to a university, indicate this in the blank with * - 1. The applicant who has more than one major at his/her university should list all the majors, including minors, in the blank with * - 2. For the certificate/degree column, please indicate UPSR, PMR, SPM, STPM or A-Level, etc. accordingly. 9. Reasons for majoring in the field of study described in item 6.
I WOULD LIKE TO FURTHER MY STUDY IN JAPAN FOR MEDICINE BECAUSE JAPAN IS ONE OF THE MOST ADVANCED COUNTRIES OF THE WORLD IN THE FIELD OF MEDICINE. I WOULD LIKE TO STUDY IN JAPAN AS IT IS THE BEST CHOICE FOR ME TO FULLFILL MY DREAM TO STUDY MEDICINE.

From _

_ d

yrs an _ 2)_______ 1)_______

mentioned above

mons

10. Description of desired employment to be taken up after returning home.

I WOULD LIKE TO BECOME A SUCCESSFUL DOCTOR AND I WILL BRING ALL THE KNOWLEDGES OF MEDICINE THAT I HAD LEARNT IN JAPAN TO MALAYSIA SO THAT I CAN USE IT WISELY TO SAVE MORE PEOPLES LIVES.

11. Person to be notified in applicants home country, in case of emergency: i) ii) Address: with telephone number, facsimile number, e-mail address ADDRESS: 51, JALAN MAS JAYA (2), TAMAN MAS JAYA, JALAN SALLEH, 84000 MUAR , JOHOR. TELEPHONE NUMBER:06-9522737 iii) Occupation: RETIRED ______________________________________________________ Name in full: KOH CHERN SIONG__________________________________________

iv)

Relationship to applicant: FATHER AND DAUGHTER Date of application: 03 APRIL 2009 Applicants signature: _________________________ Applicants name (in Roman block capitals): KOH MING JUN ______

=========================================================== Have you learnt Japanese Language before?

Yes

No

Name of Institute: ________________________________________

If yes, do you have any certificate of Japanese language proficiency?

Yes

No

Note:

Do not leave any column blank, if you do so, your application will strictly NOT be considered.