JDS Application Form 2012-2013

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9Please sign all pages at the bottom right corners"

:-eg. 2o. only)

(8ffice use

5,P,2"S" G-,2) ,%D 1 'U3,2 -"S U-C" D"6"+ P3"2) SC' +,-S'%P 75DS8 (91(-(91/ ,PP+%C,)% 2 1 -3 for 3,S)"- +"6"+ in VIETNAM 7)$is application form s$ould be #ritten clearly and completed in "nglis$. )ype#riting is preferable.8

1. Study Course
See the Application Guideline for details and tick your desired sub program!component for study" #f you mark more than one place$ your application will become in%alid"
Sub-Program Component Universities Duration 'itotsubas$i University School of #nternational and Public Policy (& years) %nternational C$ristian University Graduate School of Arts and Sciences (& years) 'iros$ima University Graduate School for #nternational 'e%elopment and (ooperation (& years) .yus$u University Graduate School of )ioresource and )ioen%ironmental Sciences (& years) University of )sukuba Graduate School of *ife and +n%ironmental Sciences (& years) 2agoya University Graduate School of law (&", years) .obe University Graduate School of #nternational (ooperation Studies (& years) 3ei4i University Graduate School of Go%ernance Studies (& years)
Please tick one you apply for

Workplace and Governing rgani!ation

1. Promotion of "conomic Gro#t$ and Strengt$ening of %nternational Competitiveness

1-1 %nstitution &uilding for Gro#t$ Promotion

1-( )ransport * Urban Development

(. %mprovements in +iving and Social Conditions and Corrections of Disparities /. "nvironment Conservation

(. ,griculture and -ural Development

/. "nvironment

0. Strengt$ening of Governance

0-1 Development of +egal 1rame#ork

0-( Public ,dministration -eforms

(. Personal %nformation
(-) .amily name/
Attach your recent photograph here (Should be taken within three months) Please write your name on the back of the photo (3cm4cm)

0iddle name/ ! (month)

Gi%en name / ! (year)

(Capitalized and As of written in passport or ID, if applicable) (&) 'ate of )irth/ (day)

(3) Age/ (as of application) (4) Se1/ 2 3 20 ! 2 3 . 4 (,) 0arital Status/ 2 3 Single ! 2 3 0arried

(5) (urrent 6ome Address/

7 Signature of applicant/ 1

(:) (urrent Postal Address (#f different from the abo%e$ in ;ietnamese only)/ (<) 6ome Phone/ (-?) 0obile Phone (if any)/ (--) + 0A#* Address (if any)/ (-&) (ontact Person (.amily or @elati%e)/ Phone Aumber/ (=) >ork Phone/ 77

/.

"ducational &ackground
Period of sc$ooling you $ave attended # $ears

(-) +ducational )ackground (as of application)


+evel 2ame of Sc$ool ; Department XXX University ac!lty of XXX +ocation 1rom *)o
73ont$*<ear8

Degree -ac.elor of XXX

(Ex.) Primary +ducation *ower Secondary +ducation Bpper Secondary +ducation 6igher +ducation (Bni%ersity le%el ) 8ther 6igher +ducation (e1cept training) 8ther 6igher +ducation (e1cept training)

"anoi

%&'(&&& ) %*'+%%,

)otal Sc$ool <ear= 7777777777 year7s8 >>>>>>>> mont$7s8 9'8 A8C count the year of short!training courses"

(&) 6a%e you e%er been awarded any scholarship studying abroadD 2 3 Ees Aame of Scholarship/ (ountry of study/ 2 3 Ao 'uration/ (month!year) F (month!year)

Signature of applicant/

(3) Are you currently applying for another scholarshipD 2 3 Ees Aame of Scholarship/ 2 3 Ao (4) 6a%e you e%er applied for G'S Program beforeD 2 3 Ees Study field$ uni%ersity$ year you applied9 / (+1")

*aw $ $ $

$ Aagoya $ $ $

$ &??5

(9 *ist all$ if more than one")

2 3 Ao

Signature of applicant/

0.

Work "?perience

(.ill out from the most recent Hob and attach another sheet if necessary" .ull time Hob 8A*E" Part time Hobs$ full time Hobs before graduation from Bni%ersity or period of suspension of work are not included") (-) >ork +1perience (as of application)
Period of Working , years
1rom *)o
73ont$*<ear8

Workplace

Department*Section

Position )itle

::)ype

(Ex.) /inistry of XXXX

Acco!ntin0 Division

Dep!ty Director

XX'XXXX ) XX'XXXX

** or t.e type of or0anization above, c.oose t.e applicable alp.abet below1 A" 0inistry!Go%ernmental agency ((entral or *ocal) )" State (orp" !State (o" (" @esearch #nstitution! (enter (State) '" +ducational #nstitution (State) +" 8ther (please specify)/ 7777777777777777777777777777777777777777777777

Cotal >ork Eear/ 7777777777year(s) 7777777777month(s) (Side Hobs and part time Hobs are not included)
(&) Eour current occupation (including title)/ (3) .ull name of your current 'epartment/ (4) .ull name of your current >orkplace/ (,) >ork Address/ (5) >ork Phone/ .a1/ 77777777 777777777

Signature of applicant/

@.

W$at are 7#ere8 your responsibilities at #orkA (Eour answer must be typed in 1@9 #ords or less. B3a?imum 91 7one8 pageC8" Bse separate sheet of A4 siIed paper and attach this page as a co%er"

7Current #ork8

7Previous #ork8

Signature of applicant/

D. Considering t$e Sub-Program* Component of 5DS #$ic$ you apply for on page 1E $o# #ould

you utili!e your skillsE kno#ledge and e?periences t$at you obtain in 5apan on your $ome return for contribution to development of 6ietnamA (Eour answer must be typed in 099-@99 #ords B3a?imum 9( 7t#o8 pages3" Bse separate sheets of A4 siIed paper and attach them to this page as a co%er")

Signature of applicant/

F. -esearc$ proposal
8n separate sheets of A4 siIed paper$ write a brief proposal of your 0asterJs thesis or @esearch paper" 'escribe how your study can contribute to find the solution to the problems of de%elopment of your country" #t is strongly recommended that the research proposal should be in connection with Sub program ! (omponent (as target priority area and de%elopment issues of G'S program) Eour work$ duties and future plan Bni%ersity curriculum and faculty members$ etc" 8ther details about writing your proposal are gi%en in the attached Guideline for writing a research proposal " Che research proposal must be typed$ and s$ould be no more t$an F99 #ords. B3a?imum 9/ 7t$ree8 pages.C
: Do not forget your signature on eac$ page of attac$ments.

)itle of your -esearc$ Plan=

Signature of applicant/

G.

Declaration

#$ (print your full name) 7777777777777777777777777777777777777777777777$ declare that # will apply for G'S Program with full understanding of KApplication Guidelines for G'S ProgramL$ especially the articles stipulated below/ -" All the information answered and pro%ided in this Application .orm by me is true and accurate to the best of my knowledge and ability" 0y Application will be cancelled if any information mentioned abo%e recogniIed to be false" Application .orm which is incomplete and lacking the necessary documents is regarded ineligible" All the selection procedure and its result are entirely entrusted to the secretariat of G'S and any inMuiry and obHection by applicants regarding the result of selection are not accepted" #f any act of dishonesty is found other than those abo%e in the application and selection$ # am to lodge no complaint about cancellation of the application" Che obHecti%e of the G'S is to pro%ide ;ietnamese Go%ernment officials with study in Gapan at 0asterJs le%el in order to support national efforts to achie%e social and economic de%elopment in ;ietnam" Chus$ a return fellow is under the obligation to return to ;ietnam after completing their study$ contribute to the de%elopment of ;ietnam and remain in ;ietnam at least for two years after completing 0asterJs degree in Gapan" # agree that my personal information in the Application .orm$ pro%ided to Gapan #nternational (ooperation (enter (G#(+)$ will be used only for the purpose of the operation of G'S program"

&" 3"

4" ,"

5"

Signature/ 777777777777777777777777777777
7:Please sign at t$e bottom rig$t corner of all pages including t$is page8

'ate/ (day)77777!(month)77777!(year)7777

Signature of applicant/

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