Toshihiko Tokizane Memorial Award for Excellent Graduate Study in Neuroscience

Application

Toshihiko Tokizane Memorial Award for Excellent Graduate Study in Neuroscience

To The Toshihiko Tokizane Memorial Brain Research Promotion Fund Secretariat

(Entrustee, Mitsubishi UFJ Trust and Banking Corporation)

Date:

Consent to Disclosure of Personal Information

Before you, as an applicant, submit your application, you must read and agree to the following terms and conditions:

The matters stated in this application document and the attached materials shall be referred by the Steering Committee, the Selection Committee, and the Secretariat of theToshihikoTokizane Memorial Brain Research Promotion Fund as far as necessary for the operation for such as the selection.

When awardees are decided,their names, affiliations, research themesand other information registered or submittedare to be provided to the persons concernedand opened to the public.

Name / First: Last:
Date of Birth / MM/DD/YY: ( Male / Female )
Affiliation
Affiliation
Address / Phone:
Home
Address / Phone:
E-mail
Academic background (since the entrance to an undergraduate course)
Status of PhD course
(1) Entrance (Month/Year):
(2) Completion (Month/Year):
(3) University:
(4) Graduate course:
(5) Specialty:
(6) Period of term’s leave of absence:
(7) Appending note:

Entrustee, Mitsubishi UFJ Trust and Banking Corporation, shall use applicant’s personal information in accordance with the Act on the Protection of Personal Information (Act No. 57 of May 30, 2003).

Research theme of PhD study
Select one relevant panel: (Molecular and Cellular, System or Clinical Neuroscience)
List of publications
Poster/oral presentations at the Annual Meetings of the JNS as the first author
(for JNS members)
Outline of the Graduate Study
The applicant explains her/his research, including the four points listed below (3 pages maximum). (Figures may be included. Note that this outline should be described so that neuroscientists of wide fields can understand.)
1. Scientific background of the research
2. Content of the research
3. Scientific originality and significance of the research
4. Others

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