(FORM1b) FY 2019

Nagoya University Young Leaders Cultivation Program (YLC)

APPLICATION FORM

(Use 11 point fonts to complete this form.)

Application Category
(Please check all applicable categories) / □Internal (Nagoya University) Applicant (regardless of gender/nationality)
□General Applicant □Foreigner □Female
Medium-sized Section*
Basic Section*
Applicant’s Research Expertise(s) (Write freely)
Keywords of Applicant’s Research (Write freely, five at most)
Caution!: The listing table of the above items marked with asterisk (*)(Area, Discipline, Resarch Field, Item Number) could be found in the reference documents issued by Japan Society for the Promotion of Science (JSPS), which could be downloaded as a PDF file in English version from the URL: You must fill in the blanks by picking up each item from the table as it best fits with your research expertises.
1.Name in Full
FAMILY (all capitals) First Middle
2.Title of Proposed Research
3.Date of Birth and Age (as of 2019.4.1):
/ /
Day Month Year Years Old / 4. Nationality
5.Current Appointment and/or Status
6.Academic Degree
Type (Doctor of Science, PhD, etc): / □Date Obtained / /
□Expected Day Month Year
7.Higher Education Qualification (Start from the latest one)
Name of University / Institution / Location (City & Country) / Degree / Field / Completion Date (Month, Year)
8.Previous Employment(Start from the latest one)
Name of Institution / Location (City & Country) / Position / From – To
9. Expected Research Base (Host Professor) /e-mail address(Host Professor’s)/Affiliation (Department & Graduate School) as YLC faculty
e-mail:
10. Summary of Your Past Research and Scientific Achievements (within one page)
11. Research Proposal and Plan at Nagoya University (within three pages)
a. Background and past research by others/current movement in research fields related to proposed research
b. Purpose and goal of proposed research
c. Proposed plan including time schedule of proposed research
d. Expected scientifically novel results of value and academic/social impacts
e. Future plan (post-YLC, including scheduledscientific experience in countries other than your home country and Japan) as to your scientific or job career
11. Research Proposal and Plan at Nagoya University (Continued)
11. Research Proposal and Plan at Nagoya University (Continued)
12. List ofMajor Publications, Patents, Scientific Presentations (Oral and Poster), Scientific Recognitions (within two pages)
①Publications: Authors (all), Title, Journal, Vol (No), pp. first page – last page, (Month), Publication Year
②Patents
12. List ofMajor Publications, Patents, Scientific Presentations (oral and poster), Scientific Recognitions (Continued)
③Scientific Presentations (Oral or Poster): Presenters (all), Presentation Title, Conference Name, Month and Year, Place
④Scientific Recognitions (Fellowships, Honors and Awards): Year, Title of Recognition, (and Recognized Research Subject/Title)
13. Past Graduate Studies of Applicant during the Doctoral Course
Place (Host Professor, Department, Graduate School) / Duration (From–To): / Title of Ph.D. Thesis:
Scientific experience in countries other than your home country and Japan (including your future schedule)
※The applicants in humanities and social sciences are not required, as a part of the program, to undertake scientific research in countries other than their home countries and Japan. However, the reasons for not planning to do so should be stated explicitly.
14. Mailing and contact address
a. Office: / b. Home:
Tel:
Fax:
e-mail / Tel:
Fax:
e-mail

I certify the above information to be accurate and correct.

Date:

NAME (Print) :

Signature:

Notes:

1. Please make you signature in the blank and forward this application form by e-mail and by post to your prospective host professor at Nagoya University. Do not send it directly to the Institute for Advanced Research (IAR), Nagoya University.

2. The following documents must be prepared in advance upon your request:

・TWO letters of reference/recommendation (each from prospective host professor and the Dean of Graduate School he/she belongs to.).

YLC1