University of Tsukuba

APPLICATION FORM

FORNIMS GRADUATE RESEARCH ASSISTANTSHIP

1. Full name(as it appears on your passport, write your surname in all capital letters):

Full name in Chinese character if applicable:

Gender (M/F):

Date of birth (mm/dd/yyyy):

Nationality (as shown on your passport):

2. Names of the prospective supervisors (you can write up to 3 names):

3. Correspondence address:

4. Contact details

E-mail:

Phone:

5. Current position and affiliation:

6. Education history since undergraduate(You may add the lines)

Enrollment period,
including year and month of expected completion / Education / Name of institute/university, including the names of faculty and department / Type of degree awarded
(e.g. Bachelor of ○○)
year / month
- year / month / Master’s
(Postgraduate level)
year / month
- year / month / Bachelor’s
(Undergraduate level)

7. Employment history(if applicable. you may add the lines)

Employment period / year / month - year / month
Name of the company you have worked in
Job title/position / Full time / Part time
Your primary responsibilities

8. History of research activities(if applicable. you may add the lines)

Duration / year / month - year / month
Name and address of the institute, (including the names of faculty or department)
Title/Status given for the activity

9. Current research theme and the abstract

Research Theme:

Abstract (should be about 100 words):

10. Achievement list

(1) Scientific papers:

(2) Verbal presentations:

(3) Proceedings:

(4) Others, such as patents and awards:

11. Names and affiliation of at least two references, including the email address:

(We may directly contact the references. Applicant must waive the right of access.)

12.Your future career plan after obtaining a Master’s degree

(this question is only for Master’s course applicant)

☐Doctoral course(University of Tsukuba)

☐Doctoral course (other university in Japan)

☐Doctoral course (other university outside Japan)

☐Finding employment ☐Other ( )

13. Do you apply for the “Financial Support Grant” for travel to NIMS?

☐Yes, I do ☐Not necessary

Those who check [Yes], shall answer the following question,

in case your application for the travel support would fail,

☐Youwill not attend the interviewtest in NIMS

☐ You can afford a travel expenses on your own budget

14. How did you know this program? (☒to the best answer)

☐Website of / ☐NIMS ☐University ☐Professor ☐Others

☐ Recruit Seminar by NIMS researcher

☐ Presentation @Conference by prospective supervisor

☐By professors in your university

☐ By Acquaintances

☐Others

I declare that the details provided in this entire application are true and correct, and contain no research frauds in any particular.
(Signature)
(Full name in print)
(Date mm/dd/yy)

Only for Doctoral course applicant

Research Accomplishments (within a half page)

Future Plans (within a half page)