（様式5/Form 5）

年Year / 月Month(3-letters) / 日Date
GESL Black Wednesday Evaluation Report

1:Student Information (Please fill all information in this section)

Name
Grade / M1 first semester
M1 second semester
M2 first semester
M2 second semester / D1 first semester
D1 second semester
D2 first semester
D2 second semester
D3 first semester
D3 second semester
Student ID
Name of graduate school / Graduate School of Media and Governance
Graduate School of Science and Technology
Date of enrolled in GESL / Started from: (yyyy/mm/dd) :
Selected professional area for major research / Environmental Information System Professional
Global Environmental Policy Professional
Large-Scale Environmental System Professional
Environmental Technosciene and Policy Professional
Selected professional area for minor research / Environmental Information System Professional
Global Environmental Policy Professional
Large-Scale Environmental System Professional
Environmental Technosciene and Policy Professional

2:Black Wednesday Application (Please select your desired examination at this Black Wednesday.)

International Training Report / Period: (yyyy/mm/dd) to (yyyy/mm/dd)
Theme:
Name of Institute:
Name of supervisor:
※Please attach your presentation materials for this application.
※For the students belonging to Graduate School of Media and Governance, Form 7-1,7-2 and 7-3 are required to submit within 1 month after the period.
※For the students belonging to Graduate School of Science and Technology, please check the deadline of Form7-1, 7-2 and 7-3 at GESL Guideline Section 5.
To improve your research and experience, we encourage you to consider how to discuss with your supervisor or your supervisor’s comments at BW. We already preparedthe following options, and if you succeeded to arrange it, please selectfrom the followings or describe your own.
□via Polycom: IP
□via Skype: ID
□if above, available time window(JST):
□via recorded video: file type
□other:
※If you do not have any applicable options on the above please select the following option. We will introduce the supervisor’s comments on Form 7-2 at BW on behalf of the supervisor.
□comments on Form7-2
Minor Research Presentation / Theme:
※Please attach your presentation materials for this application.
Final Presentation / ※Please attach your presentation materials for this application.
GESL RA Examination for Promotion / ※For the student who is in the second semester in a grade, please select this examination.

3:GESL International Academia-Industry-NPO Collaborative Advisory Group

(If you changed the advisory group member, please resubmit Form 4 as the attached document.)

Main Advisor / Name:
Affiliation: / face photo(if possible)
Minor Research Co-Advisor / Name:
Affiliation: / face photo(if possible)
International Co-Advisor / Name:
Affiliation: / face photo(if possible)
Co-Advisor / Name:
Affiliation: / face photo(if possible)

4:GESL Certificate Requirements

(Please select and fill allinformationthat you passed the GESL certificate requirements.)

Passed GESL Compulsory Elective Subject / Environmental Information System Architecture (Semester/Year: / )
Global Environmental Policy Management (Semester/Year: / )
Large-Scale Environmental Systems (Semester/Year: / )
Environmental Technoscience and Policy (Semester/Year: / )
Passed International Training / For Students in Graduate School of Media and Governance
Master’s Student
Fieldwork A(Semester/Year: / )
Fieldwork B(Semester/Year: / )
Internship A(Semester/Year: / )
Internship B(Semester/Year: / )
Doctoral Student
Advanced Fieldwork A(Semester/Year: / )
Advanced Fieldwork B(Semester/Year: / )
Advanced Fieldwork C(Semester/Year: / )
Advanced Fieldwork D(Semester/Year: / )
For Students in Graduate School of Science and Technology
Master’s Student
Internship A(Semester/Year: / )
Internship B(Semester/Year: / )
Doctoral Student
Internship A(Semester/Year: / )
Internship B(Semester/Year: / )
Internship C(Semester/Year: / )
Internship D(Semester/Year: / )
Passed Minor Research Presentation / Theme:
Semester/Year: ( / )
Number of International Conference Presentation for GESL Certificate Requirements / times
List of International Conference Presentations (SFC & ST):
1.
2.
Paper List / Please encircle the serial number of reference articles for Doctor’s degree examination.
List of Original Journal Papers ( SFC & ST):
1.
2.
List of Proceedings (SFC & ST):
2.
List of research work (books) that have been published by recognized publishing companies (SFC):
1.
2.
List of artworks, designs, architectures etc. that have been accepted by recognized academic societies (SFC & ST):
1.
2.
List of Awards related to research (SFC & ST):
1.
2.
Other prominent achievement (SFC):
Unique research works (presented at recognized public occasions)
1.
2.
English Skill / Name of English examination:
Score: Date: yyy/mm/dd

Major Research Report

MajorResearch Subject
Theme:
Research Goals:
Research’s Motivation:
Research Problems:
Solutions:
Progress of Major Research
Comments from the main advisor
Name of the main advisor:
Signature: / Date:

※If your main advisor can not make the above signature by unavoidable circumstances, GESL office accepts to receive this document via email, and please add your main advisor’s email as Cc list in the email.

Minor Research Report

MinorResearch Subject
Theme:
Research Goals:
Research’s Motivation:
Research Problems:
Solutions:
Progress of your Minor Research
Comments from the Minor Research Co-Advisor
Name of the Minor Research Co-Advisor:
Signature: / Date:

※If the co-advisor can not make the above signature by unavoidable circumstances, GESL office accepts to receive this document via email, and please add your co-advisor’s email as Cc list in the email.

RA Activity Report

Overview of your RAactivities
RA Team:
Motivation of the RA Team:
Daily Activities of the RA Team:
Future Directions of the RA Team:
Your contribution (figures and images are also available to express your activities)