Application Form

– providing educational and psychological support to children worldwide who have lost parents
1-6-8 Hirakawa-cho, Chiyoda-ku, Tokyo 102-8639, Japan ☎ +81 (3) 3221-0888
www.ashinaga.org
100-YEAR VISION SCHOLARSHIP PROGRAM 2015
Educational Support (Full-Scholarship) for African Students Who Have Lost Parent(s)
Ashinaga is looking for talented students from 49 Sub-Saharan African countries who have lost one or
both parents and are willing to pursue their further studies in the world’s leading universities. The applicant
must be in the final year of high school, have graduated from high school, or in the first year or second year of
university.
1. Ashinaga Educational Support for African Children
Within the next 50 years, Sub-Saharan Africa has the potential to become the largest region in the
world, not only in terms of population, but also in the size of its economy. However, it is also likely that the
gap between the rich and poor in the continent will dramatically increase. If such a situation comes to
pass, it will be even more difficult for destitute children who have lost parents to receive a decent
education.
Today, the implementation of the “Ashinaga Educational Support for African Children Who Have
Lost Parents” is one of the Ashinaga movement’s central projects. The project aims to provide higher
education opportunities to Africa’s talented children at the world’s leading academic institutions. Ultimately,
it aims to liberate bereaved children in Sub-Saharan Africa from the chains of poverty and provide them
with the education that they require to return to their homes as leaders in the fight against poverty.
2. Requirements
1. Those who have lost one or both parents (submit an official document)
2. Those who have completed 12 years of education (primary and secondary school) within the last two
years, or those who will complete 12 years of education by June 2016
3. Those who are incapable of attending university financially
4. Those who are proficient in either English, French or Portuguese
5. Those who have an outstanding academic performance at school
6. Those who can participate in the two Ashinaga preparatory programs before attending university
7. Those who are willing to return to Africa to contribute to society after graduating from university
8. Those who are not married and without children
9. Those who are in good health condition both physically and mentally
3. Application documents
1. Application forms with 1 Photo
2. Copy of school records (the last 2 years)
3. Copy of certificate of graduation or certificate of enrollment with expected date of graduation
4. Recommendation letter from a principal or a class teacher
5. Copy of Health certificate
6. Copy of official document proving loss of one or both of parents
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– providing educational and psychological support to children worldwide who have lost parents
1-6-8 Hirakawa-cho, Chiyoda-ku, Tokyo 102-8639, Japan ☎ +81 (3) 3221-0888
www.ashinaga.org
4. Apply for this scholarship
Please send the documents by E-mail, or postal service. The addresses are below:
E-mail: [email protected] (For English Speakers)
[email protected] (For French or Portuguese Speakers)
Apply Online: http://goo.gl/forms/AMEZVd7eLJ
Postal address: 1-6-8 Hirakawa-cho, Chiyoda-ku, Tokyo, 102-8639, Japan
Ashinaga Recruitment Team
Person in charge: Tomoyuki NAKAMIZU (Mr.)
Telephone: +81 (3) 3221-0814
※ All documents must be submitted in the same envelope or attached in the same e-mail.
Deadline: 29th March, 2015
(Any documents will NOT be accepted after the above date)
5. Scholarship
Ashinaga guarantees selected candidates a scholarship for 4 years of tuition, room and board, and other
living expenses. (If the university offers any kind of financial aid, the remaining balance will be granted.)
6. Selection Process
-1st Selection (Document Screening): First Week of April, 2015
Selection process through application documents and essays
(Five candidates per country will continue on to the 2nd selection)
-2nd Selection (Interviews): From Mid - April to Mid - May, 2015
Selected candidates from the 1st selection are eligible for interview and assessment test
(One candidate selected per country)
7. Other Notes
-Successful candidates will only apply to universities outside of Africa through consultation with Ashinaga
-Successful applicants must participate in the two Ashinaga preparatory program in Uganda or Senegal
(The first camp will be held from July 8th – Dec 15th, 2015. The second program will be held for one month
in the summer of 2016.)
※ Submission of these application documents does NOT guarantee an opportunity to
apply to universities through this program.
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– providing educational and psychological support to children worldwide who have lost parents
1-6-8 Hirakawa-cho, Chiyoda-ku, Tokyo 102-8639, Japan ☎ +81 (3) 3221-0888
www.ashinaga.org
100-Year Vision Scholarship Program 2015
Application Form
Sponsored by ASHINAGA
Date of application (yyyy/mm/dd): __________/______/______
*Please Complete in Capital Letters in Black or Blue Ink
Attach
Photo
Here
Family Name:
First/Given Name(s):
Date of Birth (e.g., 10 August 1990):
Sex (Circle): Male
Female
4.5 cm × 3.5 cm
Age:
Home (Physical) Address:
Mailing (Postal) Address:
Postal Code (if possible):
Nationality:
Skype ID:
E-mail:
Phone Number 1:
Phone Number 2:
*eg. Your guardian’s number, your teacher’s number
[Family Information]
Father:
□ alive
□ estranged
□ deceased
□ unknown
□ deceased
□ unknown
If deceased, state year and cause of death if known:
Mother:
□ alive
□ estranged
If deceased, state year and cause of death if known
My guardian is my:
□ Mother
□ Father
Guardian Name:
Occupation:
□ Other (
)
Telephone (mobile):
Monthly income:
Number of family members in your household:
Highest level of education reached by a family member:
Does anyone else support you other than your guardian? If yes, please specify:
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– providing educational and psychological support to children worldwide who have lost parents
1-6-8 Hirakawa-cho, Chiyoda-ku, Tokyo 102-8639, Japan ☎ +81 (3) 3221-0888
www.ashinaga.org
[Educational background and qualifications, starting with the most recent]
Year
(yyyy – yyyy)
School or Institution
Qualifications
[Academic position/class rank in your class at school or the most recent school]
□ Top 5％ □ Top 10% □ Top 25% □ Top 50% □ Below 50%
[Language Skills]
Native language:
Other language(s): Evaluate your ability as “Excellent”, “Good” or “Fair” in the blank space below.
Language
Reading
Writing
Speaking
1.
2.
3.
If you have any official score of language proficiency tests, please note them below.
Name of Exam:
score:
Name of Exam:
score:
Name of Exam:
score:
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– providing educational and psychological support to children worldwide who have lost parents
1-6-8 Hirakawa-cho, Chiyoda-ku, Tokyo 102-8639, Japan ☎ +81 (3) 3221-0888
www.ashinaga.org
[Language and Major]
Please list up to THREE subjects that you would like to study at university as your major. Please place your
favorite subject FIRST.
1. _____________________________________
2. _____________________________________
3. _____________________________________
Universities will teach their classes in one of either English, French, or Portuguese. Please choose the
language you wish to study in. You may select only ONE language.
After you have selected your desired language, please choose ONE OR MORE regions within that language
that you would be comfortable studying in. For example, if you want to study in Portuguese, you may select
Brazil and/or Portugal ONLY.
ENGLISH
FRENCH
PORTUGUESE
□ US and Canada*
□ France
□ Brazil
□ UK and Europe*
□ Canada
□ Portugal
□ New Zealand and Australia*
□ Belgium/Switzerland
□ Middle East and Asia
* Please note these areas above (with *) are extremely COMPETITIVE and you will be at a disadvantage if
you select only one of these regions.
In addition to studying in either English, French, or Portuguese, would you be willing to learn a new language
in order to go to university? If so, your application will be at a HIGH ADVANTAGE. Please check any
languages you are willing to learn.
□ Yes, I am interested in learning a new language.
I am interested in (check all that apply):
□ Greek (Greece)
□ Italian (Italy)
□ Japanese (Japan)
□ Turkish (Turkey)
□ Swedish(Sweden)
□ Polish (Poland)
□ German (Germany)
□ Dutch (Netherlands)
□ No, I am not interested in learning a new language.
[How did you learn about our program?]
□ Japanese Embassy
□ School (Please specify:
□ Ashinaga Website
□ Social Media
)
□ Other (
□ Guardian
)
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– providing educational and psychological support to children worldwide who have lost parents
1-6-8 Hirakawa-cho, Chiyoda-ku, Tokyo 102-8639, Japan ☎ +81 (3) 3221-0888
www.ashinaga.org
[Essays: Please type/write using a separate sheet of paper]
*If you choose to write, please write in print and black ink. Failure to write legibly may affect your application.
Essay 1: Please tell us why you wish to study abroad. In addition, please tell us what you wish to study at
university, and what you wish to do back in Africa after graduating from university. (maximum 500 words)
Essay 2: Please tell us about your experience losing your parent(s). How have you survived to come this far
in life after the experience? (maximum 500 words)
I hereby solemnly declare that the statements I have made on this form are true to the best of my knowledge
and belief.
Date:
Print Full Name
Signature of Applicant
Date:
Print Full Name of Guardian
Signature of Guardian
*Please note that the signature of guardian is required to complete the application.
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