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The following information will be registered for your application.
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FY20XX PD Research Fellowships Application Form
| Eligibility |
PD |
| 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 |
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| 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
|
| Sex |
2.Female |
| 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)) |
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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）
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| Doctoral degree program details |
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（3年制）(Second half of a doctoral course (following a master’s course in the first half))
|
| Completion/withdrawal |
(Western calendar) yyyy.MM
修了(Completed course) 見込(Expected) |
| Academic degree |
(Western calendar) yyyy.MM.dd
博士取得(Doctoral degree) 見込(Expected) |
| 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
|
Former JSPS research fellowships
DC (Western calendar) yyyy.MM - (Western calendar) yyyy.MM DCとして申請・採用(Applied for and accepted DC fellowship)
(Application number: XXXXX)
PD No
RPD (Western calendar) yyyy.MM - (Western calendar) yyyy.MM RPDとして申請・採用(Applied for and accepted RPD fellowship)
(Application number: XXXXX)
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Need additional page for Academic degrees, Doctoral degree program details,
and Research, job experience, etc. (Y/N)? |
Yes 
|
| Scopus Author ID |
XXXXXXXXX |
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| Relationship between your affiliated institution during graduate studies and your host research institution |
他大学等(Other university or institution) |
| Special notes regarding your graduate school academic supervisor |
I expect to complete or withdraw from my doctoral course, and my
graduate school academic supervisor is not the same as my current host researcher
(Special notes regarding your graduate school academic supervisor)
○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○
○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○
○○○○○○○○○○○○○○○○○
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Graduate school
academic supervisor |
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 |
Current
host researcher |
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 |
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 host department |
(Code)XXXX |
(Japanese)XX部 |
Evaluator 1
(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 |
| Affiliated institution code |
(Code)XXXXX |
(Japanese)XX大学 |
| Department code |
(Code)XXXX |
(Japanese)XX部 |
| E-mail address |
Email: xxxxxxxxxx@xxxx.jp |
| Evaluator 2 |
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 |
| Affiliated institution code |
(Code)XXXXX |
(Japanese)XX大学 |
| Department code |
(Code)XXXX |
(Japanese)XX部 |
| E-mail address |
Email: xxxxxxxxxx@xxxx.jp |
|
| Current address |
〒000-0000
(Address 1)○○県○○市○○
(Address 2)△△△△2-4
(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): 0000
Email: xxxxx@xxx.xxx.ac.jp
|
| Preferred contact |
1.Current address |
〒000-0000
(Address 1)○○県○○市○○
(Address 2)△△△△2-4
(Address 3)□□□□□□□□□□□□
Phone number: 00-0000-0000
Cell phone number/extension: 00-0000-0000
Email: xxxxx@xxx.xxx.ac.jp
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| Access to detailed screening results |
審査結果の開示を希望する(Yes, I would like access.） |
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