Nitori International Scholarship Application Form

Full name Gender Birthday Grade

Entrance Graduation
Major Focus
Date Date

Face photo
Currrent (3,5x4)
Home Address
Address

Citizenship No/
Place of Issue
Passport No

Cell Phone E-mail

Address
Emergency Contact
Full name Relationship Cell Phone

Full name Relationship Company/School Position Address

Family

Interests and Hobbies

Name of School Major Address Graduation date

Academic History
(High School and up)

Name Certified Organization Acquisition date

Certification

Experience/activites Positsion Detail Reference Contact Information Period

Experience and
activities(Class,Student
Organization etc..)

Place Detail Reference Contact Information Period

Volunteer or Internship
 Research Subject or
Career Plan

Other activities besides

studying and the
reasons to apply for
scholarship

I declare that the above information is true.

If the above information proves to be false,I acknowledge that I shall be disqualifled from being a candidate to receive the scholarship.

Sign: Date: