The matsumae international foundation

(MIF USE ONLY)

THE MATSUMAE INTERNATIONAL FOUNDATION
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Document #1
Application Form For The MIF Fellowship Program 2023

I would like to apply for a fellowship for the period of

1.

months between

and

(Month) (Year) (Month) (Year)

Full name (as in passport)

Mr. / Ms.

2.

(Given Name)

(Surname)

Date of Birth, and Age

Years old

3.

(Age)

(Year)

(Month)

(Day)



5.　Place of Birth

Nationality



4.
6.　Postal Address to be used by the MIF

Tel:

E-mail:

Current Institutional Affiliation (Current Employment), including Department and Faculty

7.　Name of the Nearest Airport from Your Domicile

8.　Current Institutional Affiliation (Current Employment), including Department and Faculty







Title/Position

9.　Family

Spouse Yes ☐ / No ☐
Children　Yes ☐ / No ☐
If yes, the number of children ( ), and Age ( ), ( ), ( )

M=Month, Y=Year

10.　Education History

Period				Name of Institution	Country	Academic Major	Degree
Start		Finish
(M)	(Y)	(M)	(Y)
(M)	(Y)	(M)	(Y)
(M)	(Y)	(M)	(Y)

11.　Title (subject) of Ph.D.

12.　Please list major awards or fellowships which you have received.

Name of Award Organization Period Type of Award

13.　Research Project in Japan

[Title]

[Brief Summary] Describe your research project within 10 sentences and enclose the Details in “Document #2.”

14.　Host Professor/Scholar in Japan (Please enclose his/her Letter of Invitation as “Document #7”.)

Name:
Position/Title:
Institution:

15.　Future Professional Plan

Describe your future professional plan within 10 sentences.

in which country?
16.　Please list other fellowships for which you are currently applying or planning to apply.
Name of Fellowship Organization Period Type of Fellowship

17.　Language (Evaluate by stating Excellent, Good, Fair or Poor)

Writing Reading Speaking

English

18.　Previous Stays in Japan

Period Place Purpose Financed by

19.　The reasons that you apply for the MIF fellowship program and that you choose the host professor/scholar.
Describe the reasons within A4-size, One page.

20.　I fully understand and agree to the “Fellowship Announcement”, and I hereby certify that all the descriptions above are true.

Date: Signature:
(Application without your signature is not acceptable.)

Check-List

* Please make sure to include all the required documents as instructed.

No.	APPLICATION DOCUMENTS	☒
#1	Application Form	☐
#2	Research Plan	☐
#3	Soft Copy of Publication	☐
#4	Curriculum Vitae (CV) and List of Publications	☐
#5	Recommendation Letter	☐
#6	Soft Copies of Academic Certificates/Diplomas	☐
#7	Invitation Letter	☐