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(ASEAN University Network / Southeast Asia Engineering Education Development Network)

Application Form of Doctoral Degree Progrm in Japan JFY 2017


INSTRUCTION
To fill in the AUN/SEED-Net application form, it is advised to carefully study the Program Guideline of Doctoral Degree Progrm in
Japan JFY 2017
This Application Form is in Microsoft Excel format, please type all entries in yellow box on the application form. Once completed,
please DO NOT convert the file to other file types. Converting the file type to PDF is not acceptable. Handwritten application and
other formats of the application form are prohibited.

In addition to the application form, the following "Supporting Documents" are required.
Please select YES or NO to ensure that your application is complete and that you have enclosed all documents listed below.
AUN/SEED-Net WILL NOT consider any application with incomplete documents.

* Please note that applications without an endorsement letter will not be accepted.

Document Checklist
Please answer Yes/No in the space provided for items submitted.
Compulsory
1. This application form completed with photo & signature
2.
3.
4.
5.
6.

Official Bachelors Degree certificate (certified copy only)


Official Bachelors transcript with grade points (original or certified copy)
Official Master's Degree certificate (certified copy only)
Official Master's transcript with grade points (original or certified copy)
Abstract of Master's Thesis

7. Research proposal (free format)


8. Certificate of language proficiency , e.g. score of TOEFL, IELTS or TOEIC
(In case it is difficult to submit this document, please provide the letter from the
institution where you studied your masters degree to certify the use of English
language as medium of instruction.)
9. Certified letter of Class Rank of the Bachelors and Master's study from Dean or Registrar
Office of your graduated institution (Attachment 1)
10. Endorsement Letter from Rector or Dean of Member Institution to which you
belong (with current position in case you are a faculty member)
11. One letter of recommendation from Master course's advisor (Attachment 2)
12. Copy of publication(s), if any
13. Conditional Acceptance Letter (Attachment 4)
14. Others
The AUN/SEED-Net Application Form in Microsoft Excel format must be e-mailed to phdjapan@aun-seed.net with
the subject line "Application: PhD Japan 2017. The Printed version of the AUN/SEED-Net Application Form with the
Supporting Documents must be sent to the contact person at Sending Institution for endorsement from Dean or
designated person. The Sending Institution will send the completed applications with the endorsement letter to
AUN/SEED-Net secretariat.

Cover Page

(ASEAN University Network / Southeast Asia Engineering Education Development Network)


Application Form of Doctoral Degree Progrm in Japan JFY 2017

Name:
Endorsed by:

0
Application

University

University & Field Selection

Field of Study
0

Section 1: Personal Information


Personal Information
First Name
Family Name
Gender
Nationality
Date of Birth (MM/DD/YYYY)
Age
Marital Status
Current Status
Present Position
University/Organization
Department/Division
Contact Information
Mailing Address

Photo
(Taken within
the past 6 months)

Email
Mobile
Tel/Fax
Please kindly provide valid contact information. Japanese Supporting University may contact the applicant directly for interview, or request additional information for the screening.
Endorsed by Sending Institution (SI)
* Please note that applications without an Endorsement Letter will not be accepted.
Section 2: Academic Qualification
Educational Record (Higher Education)
Please list all degrees received.
Period
No.

Institution/University

From (Month/Year)

To

Degree

Major

(Month/Year)

Cumulative Grade Point Average


(CGPA)
(Honors, if any)

Status

Class Rank
No.

Institution/University

department/
program

Degree

Placed at rank

Total Number
(Students)

CGPA

Signed by
(Name)

To verify your Class Rank, please submit Certified letter on academic standing (Attachment 1)
Thesis Topic
Please submit Thesis Abstract for the previous
degree received (if any).
English Qualification (if any, please submit the certificate)
English Proficiency Test
Score
Taken Date (MM/DD/YYYY)

Others (Please specify)

Section 3: Employment Record


Job Record (After graduation)
Period
No.

Organization

From (Month/Year)

To

City/Country

(Month/Year)

Section 4: Achievements
Other Awards (Additional page should be submitted as a separate file.)

Page no. 1 of 2

Position/Title

Brief Job Decription

(ASEAN University Network / Southeast Asia Engineering Education Development Network)


Application Form of Doctoral Degree Progrm in Japan JFY 2017
Section 5: Program Selection

Selection

University

Program/Department/
Faculty

Intake
Field of Study

Division

Proposed Advisor

Semester

Year

University and Field Selection

Section 6: Research Proposal


Research Title
(Please submit Thesis Proposal/Research Study Plan in any format)
Thesis Proposal/Research Study Plan is one of the most important factors to be considered for AUN/SEED-Net Scholarship.

Publications (journal, proceedings, etc).


List recent publications (not older than 2 years) in journals or conference proceedings in which you have published your research work. Required information for publication is 'Name of the authors/co-authors', Title of the paper, Name of the journal or
conference, Volume number and year of the publication, and page number'. Please also state if the publication is relaed to your Master's thesis. Additional page, if necessary, must be submitted as a separate file.

(Please submit the copy of your publication.)


Section 7: Statement of Purpose

For an additional page if necessary, must be submitted as a separate file.


Section 8: Medical Record
Before you complete the Medical Record Questionnaire, you are hereby notified that a medical condition resulting from an undisclosed pre-existing condition may not be financially compensated and may result in termination of your
scholarship.
1. Present Medical Status
(a) Do you currently use any medicine or have regular medical checkup by a physician for your illness?
If yes, please attach your doctor's letter (written in English) that describes current status of your illness and agreement to join the program.

Please specify

(b) Are you pregnant? If yes, please specify months of pregnancy

Please specify

2. Medical History
(a) Have you had any significant or serious illness?

Please specify

(b) Have you ever been a patient in a mental clinic or been treated by a psychiatrist?

Please specify

Section 9: Declaration
I declare that all information in this application as well as the attached documents are true and correct to the best of my knowledge. I acknowledge that the provision of incorrect information or supporting documents may result in
termination of scholarship, and that I will have to be responsible for an expenses incurred from my misinformation.
If awarded the scholarship, I agree:
(a)to abide by the rules and regulations of the Host Institution, Japanese Supporting University, AUN/SEED-Net Project, and JICA;
(b)to follow course regulations and instructions and abide by such conditions as may be stipulated by both the host institution, Japanese Supporting University, and AUN/SEED-Net in respect of this course of study;
(c)to refrain from engaging in political activities, or any form of employment for profit;
(d)to submit any progress reports or evaluation questionaire which may be prescribed;
(e)to return to my home country at the end of my scholarship period.
I also fully understand that, the scholarship, if awarded, may be subsequently withdrawn for failure of making adequate progress, or for other sufficient cause including health condition as determined by AUN/SEED-Net.
Please specify

Do you apply for any other scholarships?


I wish to become a teaching staff or researcher at the Member Institution after my Doctoral Degree study under the AUN/SEED-Net Project.
Signature:

Date:

Page no. 2 of 2

Questions

1. First Name

2. Family Name

3. Gender

4. Nationality

5. Date of Birth
(MM/DD/YYYY)

SN ID
1
2
3
4
5

Section

Topic
Personal Information

Items

Answers
0
0
0
0
30-Dec-1899

6. Age

7. Marital Status

8. Present Position

9. University/Organization

10. Department/Division

11. Mailing Address

6
7
8
9
10
11

Section 1: Information about the Applicant

Current Status
Contact Information

0
0
0
0
0
0

12. Email

13. Mobile

14. Tel/Fax

Endorsed by SI

[1] Degree

[1] Institution/University

12
13
14
15
16
17

Contact Information
Degre

0
0
0
0
0
0

[1] Major

[1] Period: From


(Month/Year)

[1] Period: To
(Month/Year)

[1] CGPA

[1] Status

[2] Degree

18
19
20
21
22
23

Degree (1)

0
30-Dec-1899
30-Dec-1899
0
0
0

[2] Institution/University

[2] Major

[2] Period: From


(Month/Year)

[2] Period: To
(Month/Year)

[2] CGPA

[2] Status

24
25
26
27
28
29

List All Degrees (Max. 3)

Degree (2)

0
0
30-Dec-1899
30-Dec-1899
0
0

[3] Degree

[3] Institution/University

[3] Major

[3] Period: From


(Month/Year)

[3] Period: To
(Month/Year)

[3] CGPA

30
31
32
33
34
35

Section 2: Academic Qualification

Degree (3)

0
0
0
30-Dec-1899
30-Dec-1899
0

[3] Status

[1] Institution/University

[1] Degree

[1] department/
program

[1] Placed at rank

[1] Total Number


(Students)

36
37
38
39
40
41

2: Academic Qualification

Clas

Class Rank (1) Bachelor's

0
0
0
0
0
0

[1] CGPA

[1] Signed by
(Name)

[2] Institution/University

[2] Degree

[2] department/
program

[2] Placed at rank

42
43
44
45
46
47

Class Rank (Max. 2)

Class Rank (2) Master's

0
0
0
0
0
0

48

49

50

Thesis

English
Qualification

English Qualification

Other Test; specify

English Qualification

English Proficiency Test


(TOEFL/IELTS)

English
Qualification

Thesis Topic

Thesis

[2] Signed by
(Name)

53

[2] CGPA

52

[2] Total Number


(Students)

ank (2) Master's

51

Score

Taken Date
(MM/DD/YYYY)

[1] Organization

[1] Period: From


(Month/Year)

[1] Period: To
(Month/Year)

[1] City/Country

54
55
56
57
58

English Qualification
59

English Qualification

Job (1)

0
30-Dec-1899
0
30-Dec-1899
30-Dec-1899
0

60

61

62

63

64

65

Section 3: Employment Record


Job Record (After graduation)

Employment Record (Max. 3)

[1] Position/Title

[1] Brief Job Decription

[2] Organization

[2] Period: From


(Month/Year)

[2] Period: To
(Month/Year)

[2] City/Country

Job (2)

30-Dec-1899

30-Dec-1899

[2] Position/Title

[2] Brief Job Decription

[3] Organization

[3] Period: From


(Month/Year)

[3] Period: To
(Month/Year)

[3] City/Country

66
67
68
69
70
71

nt Record
aduation)

(Max. 3)

Job (3)

0
0
0
30-Dec-1899
30-Dec-1899
0

[3] Position/Title

[3] Brief Job Decription

Awards (If Any)

(1) University

(1) Department/Faculty

(1) Field of Study

72
73
74
75
76
77

Section 4:
Achievements
Section 5: program Selection

1 Selection

Achievements/
Awards
1st Priority

0
0
0
0
0
0

78

79

80

81

82

83

Section 6: Proposed Research


Study Plan

Section 5: program Selection

6.2 Publications
(journal,
6.1 Research
proceedings,
Title
etc). Within 2
years

1 Selection

(1) Division

(1) Preferred Advisor


(if any)

(1) Intake Semester

(1) Intake Year

6.1 Research Title

6.2 Publications (journal,


proceedings, etc). Within
2 years

1st Priority

84

85

86

87

88

Section 7:
Statement of
Purpose

89

Section 8: Medical Record

Statement of
Purpose

Please specify 0

Past (a)

Present (a) IF Yes

2.Past Medical Histor

Present (b) IF Yes

Present (a)

Present (B)

Statement of Purpose

1.Present Medical Status

Please specify 0

90

91

92

93

Record

94

95

Section 9: Declaration

Please specify 0

Please specify 0

Section (9) Date

Section (9) Signature

Apply for other


scholarship?

Section 9: Signed

Past (b) IF Yes

Past (B)

Past (a) IF Yes

2.Past Medical History

30-Dec-1899

Completed & Signed


Application Form

B Certificate

B Transcript

M Certificate

M Transcript

Abstract of Master Thesis

1
2
3
4
5
6
Cover Page

Document Checklist

Compulsory

0
0
0
0
0
0

Research Proposal

Certificate of English
Proficcienty

Certified Letter of Class


Rank

Endorsement Letter

Recommodation Letter

Copy of Publication

7
8
9
10
11

Cover Page

Document Checklist

Compulsory

0
0
0
0
0
0

0
Other