application form 2016

APPLICATION FORM 2016
(To be filled in by typing)
United Nations/Japan Long-term Fellowship Programme
“Post-graduate study on Nano-Satellite Technologies (PNST)”
(Deadline for submission: 17:00 24 January 2016)
Nominee’s full name:
(Family name)
(First name)
(Middle name)
（Write your name exactly as it is printed in your passport）
Nominee's institution and country:
Degree seeking (check one)
Master
Please
include/attach a
recent
photo
here
Doctorate
The fully completed application form and all other required documents except the referee report
forms should be submitted at the web address that is in the confirmation e-mail that you will receive
after registering for the programme, in electronic format (.doc or .pdf) no later than 17:00 24
January 2016. The Referee report forms should be sent by email to the Post-graduate study on
Nano-Satellite Technologies (PNST) ([email protected]) email address by the
referees themselves by no later than 17:00 24 January 2016. For submission details see the
information note.
Selected candidates will be notified by e-mail in March 2016 and should then confirm their
acceptance of the offer no later than 5 days after notification.
Name, official title and professional relationship of three referees who are familiar with the
applicant's work and qualifications:
Name
Title
Relationship
1.
2.
3.
Note: Do not fill with handwriting except signature. Please type in with a computer.
Office for Outer Space Affairs, United Nations Office at Vienna, Wagramerstrasse 5, 1400 Vienna, Austria
Tel. (+43-1) 26060-0, Fax (+43-1) 26060-5830, www.unoosa.org
DEGREE FIELD
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Aerospace Engineering
Mechanical Engineering
Control Engineering
Electronics and Electrical Engineering
Civil Engineering
Chemical Engineering
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Material Science
Systems Engineering
Information Technology
Biomechanics
Brain Science
Other:
Please state the grade point average (GPA) of your study according to the scale and grading system in
your institution and specific maximum GPA.
During Undergraduate
During Master Study
＿ / 10
＿ / 10
RELEVANT COURSES, WORKSHOPS, SEMINARS OR MEETINGS
(attended in the last five years.)
Location
Title of activity
Duration (dates)
Sponsors
TECHNICAL SKILLS & RATE OF ABILITY
Please write freely about your technical skills, and ＿ / 10 your rate of ability.
PNST Application Form 2016
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STATEMENT OF PURPOSE
Name
Explain your reasons for applying to participate in this Fellowship Programme at Kyutech.
Please include the answer to the following questions;
Q1. What is your motivation to participate in this programme and what is your post-degree
plan?
Q2. How do you plan to participate in your home country’s space program? What capacity
currently exists in your country?
Q3. Tell us briefly what research (or work) you are doing now.
Q4. Tell us briefly about your academic background, what you did during Master or
undergraduate-degree studies.
Q5. What do you want to do as your research work for the Master or Doctor degree?
You may use separate sheets of paper (max 1,200 words).
PNST Application Form 2016
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ABSTRACT OF MASTER or BACHLOR THESIS
Name
If you have not finished your Master’s or Bachelor’s degree at the time of application, write a
progress report. You may use separate sheets of paper (max 2,000 words).
Title of thesis ________________________________________________________
PNST Application Form 2016
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CERTIFICATION OF KNOWLEDGE OF ENGLISH
Name of candidate:
ABILITY TO UNDERSTAND SPEECH
‰ Understands without difficulty
‰ Understands almost everything
‰ Requires frequent repetition
ABILITY TO WRITE
‰ Writes with ease and accuracy
‰ Writes slowly
‰ Writes with difficulty
Other remarks:
TOEIC Certificate: □ YES
TOEFL Certificate: □ YES
ABILITY TO SPEAK
‰ Speaks fluently
‰ Speaks intelligibly
‰ Speaks haltingly
ABILITY TO READ
‰ Reads fluently
‰ Reads slowly
‰ Reads with difficulty
□ NO IELTS: □ YES
□ NO
□ NO Cambridge English (ESOL) □ YES
□ NO
Certification by language examiner.
Language tested by
________________________________________________________
(Name)
________________________________________________________
(Title of examiner)
________________________________________________________
(Institution, city, country)
_________________
Seal of Language
Institution
Signature of examiner:
Note: Final candidates who are selected as MEXT fellowship candidates are requested to submit
score of one of the internationally acknowledged English exams to Kyutech by the end of June.
Date of examination:
CANDIDATE'S CERTIFICATION
I hereby certify that the statements that I have made in this application form are true, correct and
complete.
If selected, I hereby confirm that I will comply with the Terms of Reference of the
Programme and I will make myself available for duration of the entire Fellowship.
Date:
PNST Application Form 2016
Signature of candidate:
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