B ILATERAL JAPANESESWISS SCIENCE AND TECHNOLOGY PROGRAM APPLICATION FOR

0 13ª SESIÓN LOS ACUERDOS MULTILATERALES SOBRE EL MEDIO
197-511-9_Memoria_conjunta_proyecto_bilateral_Brasil
2 COMO RESULTADO DE LA ACCIÓN UNILATERAL VOLUNTARISTA DE

239-605-11_Memoria_Conjunta_Bilateral_India_2011
26 AUGUST 2011 MULTILATERAL AID ALLOCATIONS AND THE GLOBAL
4TH DRAFT (8811) 1ST USCHILE BILATERAL WORKSHOP ON MANAGEMENT

B B ILATERAL JAPANESESWISS SCIENCE AND TECHNOLOGY PROGRAM APPLICATION FOR ilateral Japanese-Swiss Science and Technology Program

APPLICATION FOR YOUNG RESEARCHERS’ EXCHANGE PROGRAM

BETWEEN JAPAN AND SWITZERLAND 2020

Part A. Personal Details and Home Institution

A1: Personal Details:

Family name:
First name(s):
Title:
Academic degree:
Current position:
Date of birth:
Gender:
Nationality:
Home Institution:
Address:
Postcode, city:
Country:
E-mail:
Phone number:

A2: Educational Background

Field Name of University/Institute (Expected) Date Obtained

Bachelor's degree

Master’s degree

Doctoral degree

A3: Supervisor at home institution

Family name:
First name(s):
Title:
Academic degree:
Institution:
Address:
Postcode, city:
Country:
E-mail:
Phone number:

Note: Please attach a letter of recommendation from your supervisor at the home institution explaining why an exchange with a specific host research in Japan is planned.

A4: Employment Record (if applicable, begin with your most recent employment.)

Name of Institution Period of Employment Position

A5: Language Ability (Evaluate your ability using excellent, good and fair.)

Writing Reading Speaking/Hearing

English

Japanese

Part B. Status of Current Research and Research Plan

B1: Project Title:

B2: Subjects and Achievements of Past Research (Max. 1 page.)

B3: List of Major Publications

Authors (all) Title Journal Vol,No.,pp.-, Month/Year

B4: Academic Awards (Please indicate title and year.)

B5: Research Plan for your stay in Japan (max 5 pages)

Please include at least the following items: 1) present research, 2) proposed research to be conducted in Japan, 3) expected outcome of the proposed research.
In describing your proposed research in Japan, please specify necessary equipment, reagents, etc. for conducting the said research.

*Additional sheets may be attached if necessary.

Part C. Host Institution and Research Stay

C1: Details of Proposed Host Researchers and Host Institutions:

Family name:
First name(s):
Title:
Academic degree:
Institution:
Address:
Postcode, city:
Country:
E-mail:
Phone number:

Note: Please attach a letter of acceptance/invitation from your proposed host researcher, stating that he/she accepts you at his/her institution.

C2: Past Stay(s) in Japan

Place Duration Purpose

C3: Proposed Stay in Japan:

Project Title:
Keywords:
Priority research area:
Intended starting date:
Duration (months):

C4: Suggested Reviewers

Please suggest at least three possible reviewers for this proposal (or anybody who should not be asked to review this proposal, preferably from Switzerland): Please provide their names and current contact information.

D. Final Statement

D1: Mailing Address:

1) Office:

2) Home:

Tel: Tel:

Fax:

E-mail:

Fax:

E-mail:

D2: Person to be notified in your home country in case of emergency:

(Be sure to fill out the information requested as it may be needed in the case of an emergency.)

1) Name in full:

2) Address and telephone and/or facsimile number and e-mail address:

3) Relationship to you:

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I certify the above information to be accurate and correct.

Date:

Signature:

ACTA DE LIQUIDACIÓN BILATERAL DEL CONTRATO DE XXXXXXXXXXXXXXXX NO
ACUERDO BILATERAL ENTRE LA UNIVERSIDAD DE CATANIA (ITALY) ENTER
ACUERDO MULTILATERAL M150 RELATIVO A LA CLASIFICACIÓN DE CONTAMINANTES

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