Bilateral Japanese-Swiss Science and Technology Programme

APPLICATION FOR YOUNG RESEARCHERS’ EXCHANGE PROGRAM

BETWEEN JAPAN AND SWITZERLAND2018

Part A. Personal Details and Home Institution

A1: Personal Details:

JSPS Research Fellow ID:
Family name:
First name:
Name (in Japanese)
Title:
Academic degree:
Current position:
Area, Discipline ,Research field:
Research field number:
Date of birth (MM/DD/YYYY):
Gender:
Nationality:
Home institution:
Address:
Postcode, city:
Country:
E-mail:
Phone number:

A2: Educational Background

Field Name of University/Institute (Expected) Date Obtained

Bachelor's degree

Master’s degree

Doctoral degree

A3: Supervisor at home institution

Family name:
First name:
Title:
Current position:
Institution:
Address:
Postcode, city:
Country:
E-mail:
Phone number:

Note: Please attach a letter of recommendation from your supervisor at the home institution explaining also why an exchange with a specific host research in Switzerland is planned.

A4: Employment Record (if applicable, begin with your most recent employment.)

Name of Institution Period of Employment Position

A5: Language Ability (Evaluate your ability using excellent, good and fair.)

Writing Reading Speaking Listening

English

( )

Part B. Status of Current Research and Research Plan

B1: Project Title under your JSPS Research Fellowship:

B2: Subjects and Achievementsof Past Research (Max. 1 page.)

B3: List of Major Publications

Authors (all) Title Journal Vol,No.,pp.-, Month/Year

B4: Academic Awards (Please indicate title and year.)

B5: Research Plan for your stay in Switzerland (max 2 pages)

・Please include at least the following items:

1) The current research you are conducting under your JSPS Research Fellowship

2) The research you plan to conduct in Switzerland

3)The relationship between 1) and 2) [the significance of your research visit to Switzerland within the context of your research plan as a JSPS Research Fellow]

4) Theexpected outcome of your proposed research in Switzerland

・In describing your proposed research in Switzerland, please specify necessary equipment, reagents, etc.for conducting the said research.

*An additional sheet may be attached if necessary.

Part C. Host Institution and Research Stay

C1: Details of Proposed Host Researchers and Host Institutions:

Family name:
First name(s):
Title:
Current position:
Institution:
Address:
Postcode, city:
Country:
E-mail:
Phone number:

Note: Please attach a letter of acceptance/invitation from your proposed host researcher, stating that he/she accepts you at his/her institution.

C2: Past Stay(s) in Switzerland

Place Duration Purpose

C3: Proposed Stay in Switzerland:

Project Title:
Keywords:
Priority research area:
Intended start:
Duration (months):

D. Final Statement

D1: Mailing Address:

1) Office:

2) Home:

Tel: Tel:

Fax:

E-mail:

Fax:

E-mail:

D2: Person to be notified in your home country in case of emergency:

(Be sure to fill out the information requested as it may be needed in the case of an emergency.)

1) Name in full:

2) Address and telephone and/or facsimile number and e-mail address:

3) Relationship to you:

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I certify the above information to be accurate and correct.

Date:

Signature: