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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）
|
| 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)
|
Need additional page for Academic degrees, Doctoral degree program details,
and Research, job experience, etc. (Y/N)? |
Yes 
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| 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 on doctoral course studies |
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 on doctoral course studies)
○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○
○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○
○○○○○○○○○○○○○○○○○
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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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