Application Form for “2018NIG-JOINT (B)”
National Institute of Genetics
Research Organization of Information and Systems
Date:
To the Director-General,National institute of Genetics,
ResearchOrganization of Information andSystems
(For the following box, please fill in for only Japanese Institution.
Keep it blank for non-Japanese Institution.)
Name of Administrator of Institution you belong to(No seal required.)
(Last Name) (First Name)
Position Title:
I hereby apply for the NIG-JOINT (B)
１．Applicant for NIG-JOINT
Applicant / AffiliationJob title
Name
Address
Phone/Fax Number
E-mail address
２. The title of research project
Title of JointResearchNew or Continuation / New / Continuation (from FY year）
In case of “continuation”, your project was accepted as □Collaborative(A) or □Collaborative(B) in previous fiscal year.
(Please check the appropriate box.)
Period of Research / Date: April 1st,2018 ～March 31st, 2019
Name of NIG representative
As an option, you can simultaneously apply for“NIG-JOINT (A)”, in case where (B) application is not approved. If you wish to take this option, please fill in “○”mark in the next space.
３．Total Budget
Total Cost of Amount(Estimated amount) / 922,000yen / (Up to 1 millionJPY: total amount of travel and research expenses)
※It must be equal to the “Total Cost of Amount” in “#6. Detailed description of necessary expense.”
４．Details for the Joint Research（Please fill in specifically and briefly）
* When columns are too short, you can extend them electronically.
①Purpose of theJoint Research and expected achievements.(In case of continuing project, please state your major achievements in previous fiscal year and the reason for continuation.)
Ex.
The purpose of this research is to figure out ...... We will conduct ...... to accomplish this purpose.
The achievements expected from this research are ......
......
......
②Necessity, plan and methods for the Joint Research
Ex.
The reasons for conductingjoint research with Prof...... in your institute are as follows.
1.By taking advantage of his achievement, we can expect ......
2.We need to have a meeting with you and utilize ...... in your institute to conduct this research successfully.
......
......
The research plans are as follows.
1. Obtain...... from......
2. Derive...... from...... to figure out ...... in full detail.
3. Determine ...... by conducting......
4. Study on ...... with obtained ......
5. Build a database of ......
We hereby apply for the joint research with your ..... laboratory to conduct this research as described above.
......
......
③Others(additional request for the Joint Research, if any.)
Ex.
We would like to bring our graduate student who is actually carrying out this research to the meeting.
The experiments of
recombinant DNA / Yes・No / (if yes) Name of NIG Principal Investigator
The usage of experimental animals / Yes・No / (if yes) Name of NIG Principal Investigator
(if yes)Whether animal experiment will be conducted by outside researcher or not. / Yes ・ No
Use of isotope / Yes・No
※The person in chargeof the experiment must be a NIG researcher.
※If any of animal experimentsare directly conducted by outside researchers, they are required to apply for NIG qualification screening and undergo a training.
５．Joint Research members（includingapplicant andNIG researcher）
*When columns are too short, you can extend them electronically.
Name / Affiliation・JobDenta Mishima / **University, **laboratory, Professor
)
Sakiko Sakura / **Institute, ** Laboratory, Assistant Prof.
６．Detailed description of necessary expense
（Number of visit must be more than 7 days in total during the research period）
Details / Fill out the details / *Unit Price / Numberof Visitors / Number
of Visits / *Amount
Travel Expense
(including daily pay and
accommodation
fee.) / Ex
Tokyo－Mishima, Single -day
Tokyo－Mishima, Overnight / 11,540 yen
16,540 yen / 2
1 / 6
2 / 139,000 yen
(11,540×2×6)
33,080 yen
(16,540×1×2)
Subtotal / 172,000 yen
Research
Expense / (Supplies,equipments etc…)
Ex.
Experimental Animal
Laboratory Instrument
Chemicals / 200,000 yen
250,000 yen
300,000 yen
Subtotal / 750,000yen
※Total Cost of Amount (Up to 1 million JPY) / 922,000 yen
* “Unit Price”：Please fill in the sum of round trip fare, accommodation fee (2,500JPY/night), and daily pay (faculty members and researchers:2,500JPY/day, Students:1,500JPY/day). As a general rule, you need to stay at the guest house on our premises.
*“ Amount”：Please fill in the sum of “Unit Price” by “Number of Visitors” by ”Number of Visits”.
* If visiting by airplane, travel fee between Narita Airport and JR Mishima station is 6,990 yen (one-way) and Haneda Airport and JR Mishima station is 4,930 yen (one-way).
You can simultaneously apply for “NIG-JOINT (A)”, in case where (B) application is not approved.
If you wish to take this option, please fill in your budget (up to 200,000 JPY) below.
Total Cost of Amount (Estimated amount） / ,000 Yen( Up to 200,000 yen）Details / Fill out the details / *Unit Price / Number
of Visitors / Number
of Visits / *Amount
Travel Expense
(Including
daily pay and accommodation fee.)
Total / yen
７．Is this Research supported by any other major grant of funds? Yes ・ No
(If yes, please fill in below)
Name of Research grant / Research project title（Research period） / Amount allocated
（ ,000yen）
Ex)
xxxx Research Grant
xxxx Promotion Foundation / xxxxx(from FY2015-FY2018)
xxxxx(from FY2017-FY2019) / 3,000
4,500
８. Research Achievements of the Applicant(Please fill in the achievement related to this Research
Project)
Publication Date / Title (Papers in press etc…)Ex.
yy/mm
yy/mm
yy/mm / Ex
1. Title of Essay
○○○○、 ××××、△△△△ (No. of other authors. Your order)
Science vol.**, issue **, pp.51-58 (2010)
2. ･･･
3. ･･･
９Research profile of the Applicant
Ex.yy/mm Ph.D... Faculty of Life Science, ○○University
yy/mm – yy/mm JSPS Research Fellow (××Laboratory, Graduate School of ××University)
(Title of Research Subject)
yy/mm Research Assistant, Faculty of ××, ××University
(Research Area, etc.)
yy/mm Associate Professor, ××University, Up to present
Application Form for NIG-JOINT(B) 1/4