 |
 |
Confirm Application Information
|
 |
The following information will be registered for your application.
If all is correct, click [Next].
FY20XX DC2 Research Fellowships Application Form
| Eligibility |
DC2 |
| Basic section code |
25010 |
| Basic section name |
Social systems engineering-related |
| Document review section |
社会システム工学関連分野(Social systems engineering and related fields) |
| Panel review section |
工学系科学(Engineering sciences) |
| Major field of studies |
情報科学 |
| Title of research proposal |
研究課題名テスト |
|
|
| Name |
Name to be registered |
(Furigana) (Family Name)ヨウセイ
(First Name)イチロウ
|
(Kanji, etc.) (Family Name)養成
(First Name)一郎
|
| Name in the family register, or on your passport or residence card |
(Furigana) (Family Name)ヨウセイ
(First Name)イチロウ
|
(Kanji, etc.) (Family Name)養成
(First Name)一郎
|
| Name in alphabet |
(Alphabet) (Family Name)YOUSEI
(Given Name)Ichiro
(Middle Name)Middle
|
| Sex |
1.Male |
| Nationality |
Other than Japan
XXX XXXXXXX
(Permanent residency status (Y/N): 有(Yes)) |
| Date of birth |
October 1, 1980 (Western calendar) (42 years old as of April 1, 2023 (Western calendar)) |
|
Academic degrees
(Bachelor’s/Master’s) |
1. 年 月 大学 学部 学科卒
2. 年 月 大学大学院修士課程入学
（ 研究科 専攻）
|
| Status of doctoral studies |
Date of enrollment |
(Western calendar)yyyy.MM
編・転・再入学(Transfer/re-enrollment) |
Total enrollment period
at time of
transfer or re-enrollment |
X year(s) X month(s) |
| Name of university |
(Code)XXXXX |
(Japanese)XX大学 |
| Name of graduate school |
(Code)XXXX |
(Japanese)XX部 |
| Major field of studies |
ＸＸＸＸＸＸ専攻 |
| Type of doctoral course |
博士課程(医・歯・薬・獣医学系4年制)(4-year doctoral course for medical, dental, pharmaceutical, or veterinary degrees) |
| Period of leave from doctoral course studies |
(Total) X year(s) X month(s) |
Total length of enrollment in doctoral course as of
April 1, XXXX (Western calendar) |
X year(s) X month(s) |
| Research, job experience, etc. |
1. 年 月 〜 年 月
|
Need additional page for
Academic degrees, Status of doctoral course studies,
and Research, job experience, etc. (Y/N)? |
Yes  |
| Scopus Author ID |
XXXXXXXXX |
| Special notes on doctoral course studies |
My current academic supervisor is not the same as my host researcher after awarded fellowship
(Special notes on doctoral course studies)
○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○
○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○
○○○○○○○○○○○○○○○○○
|
Current
academic supervisor
(who will prepare your evaluation report)
*Must be your academic advisor of record.
|
Name |
(Furigana) (Family Name)シンセイ
(First Name)イチロウ
|
(Kanji, etc.) (Family Name)申請
(First Name)一郎
|
| Job title |
(Japanese)教授 |
| e-Rad Researcher no. |
XXXXXXXX
|
| Affiliated institution code |
(Code)XXXXX |
(Japanese)XX大学 |
| Department code |
(Code)XXXX |
(Japanese)XX部 |
| E-mail address |
Email: xxxxxxxxxx@xxxx.jp |
| Host researcher after awarded fellowship |
Name |
(Furigana) (Family Name)シンセイ
(First Name)イチロウ
|
(Kanji, etc.) (Family Name)申請
(First Name)一郎
|
| Job title |
(Japanese)教授 |
| e-Rad Researcher no. |
XXXXXXXX
|
| Affiliated institution code |
(Code)XXXXX |
(Japanese)XX大学 |
| Department code |
(Code)XXXX |
(Japanese)XX部 |
| E-mail address |
Email: xxxxxxxxxx@xxxx.jp |
Official name of graduate school in which
applicant will enroll after awarded fellowship |
(Code)XXXX |
(Japanese)XX部 |
| Current address |
〒000-0000
(Address 1)○○県○○市○○
(Address 2)○○県○○市○○
(Address 3)
Phone number: 00-0000-0000
Cell phone number: 00-0000-0000
Email: xxxxx@xxx.xxx.ac.jp
|
Affiliated institution
(Location, name of institution, department, etc.)
|
〒000-0000
(Address)○○県○○市○○
(Name of institution, department, laboratory, etc. 1)○○大学○○研究科○○専攻○○
(Name of institution, department, laboratory, etc. 2)○○大学○○研究科○○専攻○○
Phone number: 00-0000-0000
(Extension): 00-0000-0000
Email: xxxxx@xxx.xxx.ac.jp
|
| Preferred contact |
1.Current address |
〒000-0000
(Address 1)○○県○○市○○
(Address 2)○○県○○市○○
(Address 3)○○県○○市○○
Phone number: 00-0000-0000
Cell phone number/extension: 00-0000-0000
Email: xxxxx@xxx.xxx.ac.jp
|
|
|