Application for the JSPS London Symposium/Seminar Scheme FY2016

Applications should be typed.

Please use the space provided as a guideline for the depth of answer required.

1. Applicant Information:
Title (Dr., Professor etc): / Gender:
 Male
 Female
Name:
Position:
Affiliation:
Tel No:
E-mail:
Postal Address:
Fellow ID No:
2. Information of Japanese Scientific Lead:
Title (Dr., Professor etc): / Gender
 Male
 Female
Name:
Position:
Affiliation:
Tel. No:
E Mail:
Postal Address:
3. Type of Event:
 Symposium  Seminar
4. Objective of Symposium (please explain in layman terms, the purpose of the symposium, including background of the topic, originality and significance of the science involved):
5. Expected impactof the symposium and plan for follow-up activity to developlong-lastingUK/RoI-Japan research collaboration:
6. Plan of Event:
a.) Draft Programme (please include the following details : title, venue, dates, speakers, involvement of early career researchers,expected number of participants, topics and description of content):
b.) Explanation of institutional or departmental level involvement(please explain how the symposium will be supported by the lead institution). This information is mandatory for a symposium, but optional for a seminar:
7. List of all Speakers:
※Please put a circle next to the Japanese speakers who require support from JSPS London to cover travel costs.
Name / Affiliation / Position
8. Expenditure (please provide a breakdown of estimated costs):
Type of Cost: / Amount to be provided by theUKlead institution or other funding organization: / Amount requested from JSPS London(excluding support of travel costs for Japanese speakers):
TOTAL £:
9. Supporting Documents (please be sure to attach the following with your application):
a.) CV of applicantand co scientific lead
b.) CV of Japanese speakers whose travel costs have been supported by JSPS.
c.) Letter of support from lead institution(for a symposium only)
※Max. 1 A4 page for CVs and 1 A4 page for publications should be submitted for each person.
10. Signature and Date:
I certify that the information provided on this Application Form is complete and accurate. I accept all terms, conditions and notices contained in the guidelines for submitting this application.
Applicant’s signature (written)
Date
Please send the completed Application Form by post to Ms. Polly Watson at: JSPS London, 14 Stephenson Way, London NW1 2HD

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