Application Form Note that fields marked with a preceding asterisk (*) are required. Please fill this form in English. Full name: (Last name, First, [Middle])* Gender* MaleFemale Nationality* Date of Birth (DD/MM/YYYY)* // Date of initial enrollment at the University of Aizu (MM/YYYY)* / Intended date of course completion (MM/YYYY)* / Current address of residence in Aizu* Student ID * List full names and relationship of all family members or dependents living with you in Japan (e.g., John Smith - Father; Dora Smith - Mother; etc.). If you live alone, please write "none".* Name the scholarships (or other supports) you have received in the past three years. If you have not received financial support in the past three years, write "none" in the first text field. Scholarship Amount (yen) from (MM/YYYY) to (MM/YYYY) * Current income per month Source Amount (yen) Scholarship * Family support * Part time job * Other support * Submit your latest official academic performance transcript. (The file must be .pdf less than 4MB)* Submit a document explaining in as much detail as possible why you are applying for this scholarship.* This online application form was originally developed by Koichi Sato.