Leadership Development Program for Space Exploration and Research

Leadership Development Program for Space Exploration and Research

Nagoya University Program for Leading Graduate Schools

Application Form for D1 Transfer Students

(Spring Admission Use)

Date:

※Expand the blank downward appropriately. (dd / mm / yyyy )

Full Name: ,
( family name ) ( given name)
Gender: □Male :□Female Nationality:
Birth Date:
Current Status:□Student (including already graduated ) □in Working
Current Affiliation (Grade, Division, Graduate School for students, Division, Company for applicants with working experience):
Entrance Examination Date for Graduate School of Nagoya University:
Planned Major and Laboratory after admitted:
Major: Laboratory:
Working Experience: □Yes □No
Filing more than one Leading Graduate School application: □Yes□ No
If yes, indicate the school names:
Contact Address: [Phone number]
[E-mail address] @
Skype name (if you want to use Skype for interview):
Name of Supervisor at Graduate School, Nagoya University:
Contact address: [Phone number]
[E-mail address] @
Financial Aid:As a rule, you will receive a financial support as Scholarship. (Note: you cannot receive other scholarshipsdouble.) Indicate funding agencies and amount of money below if you plan to be a recipient of any stipends after admitted in this program.
Funding Agency:
e.g. Japan Student Service Organization (JASSO), Japan Society for the Promotion of Science (JSPS), etc.
Receipt amount & period:
e.g. ¥x,xxxper month for 1year, ¥x,xxxper year for 3 years,a lump-sum receipt of ¥x,xxx, etc.
Fill out the current status of curriculum taken in the program (Internal Nagoya University Transfer Applicants Only):
・Basics for Space Science and Engineering□
・Video Lectures on Space Science and Engineering□
・Lectures on Satellite SystemShort Courses on Satellite Development and Application□
(Specify )
・Others (Overview of space exploration and research, Global leadership training, etc.:
(Specify )
Interview Procedure: Interview Procedure:
・Interview will be heldat Nagoya University and arranged the time between 8:45 a.m. and6:00 p.m. on any of the daysfrom (Mon) 5th to (Fri) 9th February, 2018. Please write the time slots and the date that you are inconvenient. If you are unavailable all the date shown above, interview will be carried out by Skype. If so, indicate that Skypeinterview is your first choice and write your inconvenientdate and time (Japan time) slots during the period above.
[Important]Please note that you cannot leave this program until completion for a Ph.D.
For instance, you cannot leave the programeven if you are selected for DC1 or DC2 Research Fellowship by Japan Society for the Promotion of Science (JSPS) while you stay in the program.Please check the box below if you agree with this condition:
□I agree with the condition above.
Describe your work plan (300-400 words)
It must include the following points: Short summary of
・Yourleadership ideals
・Aspirations to activities in the program
ex) ChubuSat instrument development project, Internships, etc.
・Your future carrier plan after completing this program and your prospect howdemonstratinginternationalleadership you earn in the space related industry.