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(Continued)

Otsuka Toshimi Scholarship Foundation Scholarship Application Checklist

for FY2025

<Medicals No.25-.
Please fill in the receipt number.

katakana

identity

Date of Birth A.D. Year Month Date of birth

Last year's
receipt No.24-.
number

Documents to be submitted
check column

＜Scholarship Application Form (Please use the form designated by the Foundation)
*Continuing applicants should not transcribe previous applications. Applicants who have transcribed any part of their previous statements will not be
1 considered. Please use black ink or black ballpoint pen (erasable pens and pens with blue ink are not acceptable).
Japanese translations may be made in any format, but must be separated into separate pages. The application form and Japanese translation must not be printed on
both sides of the paper.

Letter of Recommendation (The letter of recommendation must be signed by the recommender and submitted in a sealed envelope; if you are recommending two or
2 more persons, also enclose a "Letter of Recommendation Rank and Reasons for Recommendation") Note1. Applicants in the field of engineering must use a letter of
recommendation for engineering.

1 photo (4.5 x 3.5 cm, color, from the chest up, frontal view, taken within 6 months prior to application and attached to the application form. (Photos that have been modified
3 using an application are not acceptable.)

Transcripts (original or photocopy)

(Coursework, number of credits, score, evaluation and an explanation of the evaluation. (The evaluation of courses taken, number of credits, score, evaluation, and its
4 explanation are not acceptable. Transcripts must be sent for the most recent year in which the grades or scores were given Note2. Since transcripts are required for one
year, if the most recent one is for six months, the one for the
previous year should also be attached. Transcripts from Japanese language schools or vocational schools are not acceptable. (Certificates from Japanese language schools or
vocational schools are not acceptable.)

5 Certificate of enrollment (Written in Japanese and dated on or after April 1, 2025. Photocopies are not acceptable)

Copy of certificate of residence (after the start date of application)Note3

6 (Photocopies are not acceptable. (Photocopies are not acceptable. (No copies are
acceptable if "nationality and area of residence" and "status of residence, etc." are omitted. Original or photocopy of the Certificate of Registered Matters of the Alien Registration Certificate
is not acceptable. A photocopy of the Alien Registration Certificate is also not acceptable.
(Possible)

A copy of other scholarships or research grants certifying the name of the granting organization, period, purpose of use, amount, etc.
7
(If you are currently receiving or have been selected to receive another scholarship or research grant for the period from April 2025 to March 2026)

Have you completed the application form after careful consultation with your academic advisor? Also, did you write the reception number (see Application Process
STEP04) in the five designated places? Also, did you write your acceptance number (see STEP04 for the application process) in the five designated places? In addition,
8 please write the reception number on all envelopes, including the envelope containing the letter of recommendation and the envelope in which you mailed your
application form.

Note Nominators must be contracted to teach specialized classes or research instruction at the enrolling school.
For transcripts from the school in which you are enrolled with only pass/fail evaluations, or those that will not be evaluated until graduation, attach the most recent transcript
1-- from the high school or college from which you graduated (transcripts from your home country are acceptable).

Note
2--
Note 3-- Copies of Certificate of Registered Matters of Alien Registration and Residence Card are not acceptable. Since the
certificate of residence has been prepared for "foreign nationals who legally reside in Japan for more than three months and have an address" since July 9, 2012, anything other than the
certificate of residence is not acceptable as an attached document.
 No. 25 -
Scholarship Application Form Photo must be attached.

(4.5× 3.5cm)
Please fill in the receipt number. <Medicals Color, close-up from the chest up, within
6 months
( Continuation Applicant No. 24 - / Request for continuation for a period of six
months )

Otsuka Toshimi Scholarship Foundation

Representative Director Large Otsuka Ichiro Ichiro Otsuka Date of birth Year)
(Month Month) (Day Date) (Month) (Day
I wish to apply for employment as a scholarship student at your Foundation.
Fricative name
Age full age age

name
name
(2) Date of birth A.D. Year Month day
alphabetical (of
(i) notation
the
mo

(In native Nationali nth)

language)
ty

Full name (upper case alphabetical characters)

Family name/Surname First name Middle name

(circle all that apply) (2) Field medicin Biology ・ E n g i n e e r i n g ・ Nutrition ・ Physical Education
• Dentistry ・Pharmacy ・
e
Pharmacy

Name of University / Institution Faculty ・Graduate School Department / Major

Grade (circle the appropriate course) student ID number Supervisor's name

Institution
undergraduate (course, program, etc.)
Master's course (applicable to master's counter
degree) Doctoral course (applicable to
doctoral degree)
(4-year) Doctoral program
for
years
Date of entry into Japan (followi Year and month of admission Expected Graduation/Completion Date

ng a
year (e.g. AD) month (of the counter for years (following a month year (e.g. AD) month (of the
numbe
year) number in the hito-futa-mi year)
r in the counting system)
counter for years month ~ counter for years month Educational background (start with the last school attended in your home country) ・ Occupational
hito-
(following a number (following a number background
~ futa-mi
in the hito-futa-mi in the hito-futa-mi
counting system) counting system) countin
~ g
system)
~
Educational
iv
background and
work ~
experience
~

Department in charge of international students in the university (graduate Contact person's name and furigana
school)
stay-at-home Section/Center (Furigana: (*)

foreigner
) Department in
(⑤ charge Contact telephone number of the department (person in charge) Contact department (person in charge) e-mail address
of
students and
name of
person in - -
charge

1 -- (Pharmaceut
 〒 -

Nearest train station ray (e.g. X-ray) station

(6) Individual's current

address one's home Home Dormitory Apartment Apartment Other 〕〕.
•

Cell phone number Telephone number (landline)

- - - -

Email (PC) * Please write legibly

〒 -

(7) Address in home

country

TEL. -A. -

Name of
he name (family) age Employer/Sc home address
relationship hool

fam
ily
stru
ctur TEL.
e

pare
nts
TEL.
•
spo
use
• (inbroth)
piecsofmeavt,egtable,tc.

• TEL.
sibli
ngs

TEL.

TEL.

TEL.

Receipt of scholarship or not Yes ・ No

Name of the granting

Spouse's income
(Fill in only if you have a organization:
spouse.) ⑨ (Fill in only
if you have a spouse.) Yen / Beneficiary Period: Year ～ counter (Month)
(monthly/annual)
for years
(followin
ga
number
in the
hito-
futa-mi

2 -- (Pharmaceut
 countin
g
system)

Salary (including part-time work, etc.) Yen/month (Occupation: )

)
ory
hist
se
ane
Jap
(in
)

3 -- (Pharmaceut
 rent Living expenses (food, utilities, etc.) *Excluding tuition and rent
10 living expenses
Yen/month Yen/month

Monthly income (part-time, TA, RA, etc.)

(Occupation: ()
Yes ・ No
Yen/month
( Working hours: hours/week )

remittance

Yes ・ No Yen/month (Sender continuation:

Income etc.
(Sender's family name: )
(Fill in the current status
accurately.) (11)
If you are currently receiving a scholarship, please attach a copy of the name of the granting organization, period, amount, etc.

Yes ・ No Name:

Monthly - Annual Yen (Period of receipt: Year Month～ Year

(Month)

Other income (child allowance, withdrawal of savings, etc. should also be written here)

Yen/month (Contents:
(content: 1,000 yen/month)

Reduction Application pending ・ Determined ( Full / half ) ・ Rejected Not applied for ・ Failed ・ Not applied for
and exemption
status in the There is no tuition fee waiver system ・ There is a system but no eligibility for application
first semester
⑫ tuition fee Co-payments for
tuition fee Yen/year the current fiscal suffix for names of swords, armour, musical instruments,
year etc.

Reduction Scheduled to apply ( Application is in process ・ Determined ( Full / half / % ) ・ Unsuccessful Rejected (full / half
and exemption
status in the / %)
second
semester No plans to apply ・ No tuition fee waiver program ・ Program exists but applicants are not eligible

How many days a week are there classes? (face-to-face, online, or both) Days

When do you mainly have classes/do research? Daytime ・ N i g h t t i m e ・ 50-50

How many days a week do you commute to school? (include classes and research) day (of the month)

Do you go to school/lab on weekends and holidays? Weekly ・ O c c a s i o n a l l y ・ Off

⑬ academic side
On average, what time do you spend at the university (laboratory)? Time～ Time

If you are currently receiving a research grant, please attach a copy of the name of the granting organization, period, amount, etc.

Yes ・ No Name:

Yen (Period of receipt: Year Month～ Year

(Month)

Past Research Grant Receipts Name / Monthly/Yearly Amount (circle one) / Period of Grant Receipt

Name:

(monthly/annual amount) Yen / Beneficiary period: Year Month～ Year (Month)

Where applying / pending/confirmed / monthly/annual amount (circle)

Name:

Current Scholarships (Application pending and finalized / results announced: Month/Year/Year Date of announcement: May)
⑭
Status of concurrent
application for (monthly/annual amount) Yen / Beneficiary period: Year Month～ Year (Month)
research grants
Name:

(Application pending and finalized / results announced: Month/Year/Year Date)

(monthly/annual amount) Yen / Beneficiary period: Year Month～ Year (Month)

Name / Monthly/Yearly Amount (circle one) / Period of Benefit

Past scholarship
recipients Name:
15 (Also include the
Foundation's achievements.) (monthly/annual amount) Yen / Beneficiary period: Year Month～ Year (Month)

4 -- (Pharmaceut
(use
Name:
d in
legal (monthly/annual amount) Yen / Beneficiary period: Year Month～ Year (Month)
docu
ment
s)
Income from part-time jobs and research grants will not affect your acceptance or rejection. However, if you do not provide details of your income and expenses, or if it is not possible to read
how you make a living, you will not be considered.

5 -- (Pharmaceut
 (Continued - Pharmaceuticals)

letter of
Name of recommendatio
nominee(s)
n

We recommend the above-mentioned foreign student as a qualified scholarship recipient of the Foundation.
However, if you are selected as a scholarship recipient, we will instruct you to comply with the Foundation's rules and regulations, and if you fall under any of the requirements for
suspension of benefits, we assure you that we will inform you of this immediately.

year (e.g. AD) Month

(Nominee)
(Nominee)
Date
University (graduate lecture (esp.
school) name an academic

(Name of Institution) lecture)

Position Field

Name
(Signature) mark

Phone number Email

*If there is no course or field of study, leave blank.

*The name (signature) field must be filled in by the nominator in his/her own handwriting. Substituted or typed names will not be considered.
*If you are recommending more than one person from the same laboratory (faculty advisor), please also enclose the "Order of Recommendation and Reasons for Recommendation" form.

*Must be submitted in a sealed envelope by the recommender himself/herself.

Please be specific about the following items and others. If the reasons for your recommendation are too abstract, you may not be considered.

About the nominee (opinions about his/her character and potential, significance of the theme the nominee is working on, etc.)

Reasons for continued recommendation (e.g., progress in research over the past year, results, contributions to society, personal growth and change, etc.)

If a nominee has published a paper on the results of research conducted while employed by the Foundation as a scholarship recipient, please send one reprint (photocopy acceptable) of
the paper to the Foundation office. In addition, please instruct your nominee to clearly state in the acknowledgement section of the paper that he/she has received support from the
Foundation.

-4-
 (Continued - Engineering)

letter of
Nominee's name recommendatio
n

We recommend the above-mentioned foreign student as a qualified scholarship recipient of the Foundation.
However, if you are selected as a scholarship recipient, we will instruct you to comply with the Foundation's rules and regulations, and if you fall under any of the requirements for
suspension of benefits, we assure you that we will inform you of this immediately.

year (e.g. AD) month (of the year)

(Nominee)
(Nominee) Date
University (graduate lecture (esp.
school) name an academic
(Name of Institution) lecture)

Position Field

Name
(Signature) mark

Phone number Email

Please check ☑ after checking the following

□ The nominee's research is related to medicine or pharmacy, and the nominee's research is actually aimed at collaboration and application is recognizedandrecommended.

*If there is no course or field of study, leave blank.

*The name (signature) field must be filled in by the nominator in his/her own handwriting. Substituted or typed names will not be considered.
*If you are recommending more than one person from the same laboratory (faculty advisor), please also enclose the "Order of Recommendation and Reasons for Recommendation" form.

*Please make sure to submit the sealed envelope by the recommender himself/herself.

Please be specific about the following items and others. If the reasons for your recommendation are too abstract, you may not be considered.

About the nominee (opinions about his/her character and potential, significance of the theme the nominee is working on, etc.)

Reasons for continued recommendation (e.g., progress in research over the past year, results, contributions to society, personal growth and change, etc.)

If a nominee has published a paper on the results of research conducted while employed by the Foundation as a scholarship recipient, please send one reprint (photocopy acceptable) of
the paper to the Foundation office. In addition, we ask that the nominee clearly state in the acknowledgement section of the paper that he/she has received support from the Foundation.

-4-
 year (e.g. AD) month (of the year) Date

Order of recommendation and statement of reasons for the recommendation

To Ichiro Otsuka, Representative Director, Otsuka

Toshimi Scholarship Foundation

We would like to make the following recommendation for a scholarship from the Otsuka Toshimi Scholarship Foundation.

University (graduate school) name

(Name of Institution)

post
Seal
Nominee's Name

If you are recommending more than one person, regardless of whether it is a new/continuing application, please provide the reasons in order of priority (not required if
you are recommending only one person).

Furigana:

Name:
1st
place Reason:

Furigana:

Name:
2nd
place Reason:

Furigana:

Name:
3rd
place Reason:

Please enclose your completed "Letter of Recommendation Rank and Reasons for Recommendation" with each applicant's letter of recommendation.

4-1
 ⑯ Future aspirations and progress over the past year
Please describe your future aspirations and what you have done in the past year (April 2024 - March 2025) to achieve them,andany changes in
your aspirations.
The proposal should be summarized in general terms, including punctuation, in no more than 400 words (proposals exceeding the word limit will not be considered).

200

Any document that exceeds the word limit will not be considered for review. 400 characters

● If you have made a special contribution to the Foundation that sets you apart from other scholars, please describe your role and what you gained from it.
(e.g., moderator, interviewer, interpreter, tourism leader, facilitator, performer, etc.). How would you like to contribute in the future?

5 -- (Pharmaceut
⑰P
urp
ose
of
stud
y
abr
oad
and
curr
ent
pro
gres
s
tow
ard
it

⑱Y
ear-
befo
re
goal
s
and
thei
r
achi
eve
me
nt

(⑲
Tar
gets
for
the
curr
ent
fisca
l
year
)

6 -- (Pharmaceut
 ⑳ Progress in the past year and plan for the current year regarding the research
Progress of research in the last fiscal year (April 2024 - March 2025) and changes during the past year, including achievement of goals.

(Include any failures or difficulties) and your plans for the current year* in detail.
*If you wish to continue for six months, "Research Plan for Completion."

Research Title

Please circle one (1) that applies to the progress of your research.

(1) Progress is better than planned / (2) Generally on track / (3) Slightly behind / (4) Behind

Provide in the text the reason(s) for selecting the above progress status. Changes in research plan, challenges in proceeding with the research
If there are any such issues, the reasons and measures to deal with them should also be written.
Page 1

400

440 characters (continued on next page)

7 -- (Pharmaceut
 ⑳ Progress in the past year and plan for the current year regarding the research

Page 2

600

* 800 characters or less, including punctuation. Entries exceeding the character limit will not be considered. 800 characters

● Planned conference presentations and paper submissions for the current fiscal year (April 2025 - March 2026)

Example.) Domestic presentation Oral / Poster Poster / Oral Application in progress ・ Accepted 5, Oct. Oct.
Domestic Presentations Oral ・ Poster / Submitting ・ Accepted Month Conference
name: Oral ・ Poster / Submitting ・ Accepted Month Conference
name:
Overseas Presentations Oral ・ Poster / Submitting ・ Accepted Month Conference
name: Oral ・ Poster / Submitting ・ Accepted Month Conference
name:

Papers Submitting Japanese book / English- (somebo month

Magazine Title: language dy's) side

magazine
Articles Publication / English- (somebo month
Japanese book
Decision language dy's) side
Magazine Title:
magazine

* Please fill in the official name of the journal or article.

8 -- (Pharmaceut
 ȘȘ21 Results and activities in the past year
Please describe what you have accomplished in the past year (April 2024 - March 2025).
(Results and progress during the year, including presentations at conferences, submission of papers, social contribution activities, etc.)
The proposal must be concretely summarized within 400 characters including punctuation (proposals exceeding the word limit will not be considered).

*No bullet points allowed. Applicants with poor results and progress will not be considered.

200

Any document that exceeds the word limit will not be considered for review. 400 characters

● Describe your experience of being exposed to a different culture and values as a result of your study in Japan and how you have been affected by this
experience.

9 -- (Pharmaceut
 ㉒ Research achievements in conference presentations and publications
Please enter the results from April 2024 to March 2025 and itemize details such as journal and conference titles in the detail column below.
*For journal articles, please write "name of author(s)," "title of article," "journal name," "volume," "first and last page," "year of publication (A.D.)," "whether
peer reviewed," "IF," and "DOI (Digital Object Identifier) of the article published. If there are many authors, only the top three names should be written,
and the total number of authors and the order of applicants should be listed.

Example: Domestic presentations 3 times 5, Nov. October )

1. Domestic Times （ Month / Month

Months)

2. Overseas Times （ Month Months)

3. Papers Published in Japanese Book / English Book

(Details of papers, conferences, etc.)

10 -- (Pharmaceut
 JLPT Grade ( counter (Acquired in May)
for years
(followi
㉓ ng a
Qu
alific number
atio
ns in the
• hito-
Spe
cial futa-mi
note
, countin
etc. g
system)

TOEIC Score Point ( counter (obtained in May), TOEFL score Point ( counter (Acquired in
for years for years May)
(followi (followin
ng a ga
number number
in the in the
hito- hito-futa-
futa-mi mi
countin counting
g system)
system)

Fricative name

account holder

Savings accounts at banks, Japan Post Bank, etc.

㉔ payee
Banks head office
- -
credit union branch office
- -

credit branch office

association

account number (bank, etc.)

I hereby swear that I have not made any false statements in the Scholarship Application or in any of the documents submitted, and that I have not used ChatGPT or any
other generated AI tool in completing this form.

I also agree that the Foundation may provide personal information related to this application to third parties within the scope of the project purpose.

Signature: Seal

If you have a personal seal, please affix it.

* Incomplete or unclear application materials or false information in the application will be excluded from the selection process.

11 -- (Pharmaceut
* If any false information is found in the description after employment, the employment will be cancelled.

Note for filling out the form ☆ ☆ ☆

• Except for the letter of recommendation, the application must be handwritten in Japanese or English by the applicant himself/herself.

If in English, a Japanese translation should be attached (both sides are not acceptable. (No matter what the format is, each page of the application form should be separated).

• Applicants must complete the application form in a language they can use (if the application is submitted in Japanese, the interview will be conducted in Japanese).

• Use black ink or black ballpoint pen (erasable pens and pens with blue ink are not acceptable).

• All proper nouns should be given their full names and should not be abbreviated in any way.

The information you provide will not be used for any purpose other than to carry out the Foundation's business.

12 -- (Pharmaceut