<FMT B Joint Research>
FY2014
Application Form for the 13th SEKISUI CHEMICAL Innovations Inspired by Nature Research Support Program
MM DD, 2014
Research ThemeMain
applicant / Name (age) / Area of specialty
degree / Division of roles / Amount of
application
JPY
Less than 70% of
The total
Organization
Co-
researcher / Name (age) / Area of specialty
degree / Division of roles / Amount of
Application
JPY
Less than 70% of
The total
Organization
Fill in if there are any other researchers
Total amount (JPY )
Are you in Receipt of Subsidy for this or any Similar Research? / Main Applicant
●Yes ( )
●No
Co-Researcher
●Yes ( )
●No
Note: Enter all, regardless of public subsidies, financial organizations, or subsidies from public corporations
main
Applicant / Name / (Signature) / Date of Birth / MM/DD/YY
(Age: )
Organization / Qualifications
Position
Address
Contact Information / TEL: / FAX:
E-mail:
Applicant History (Enter final education, and everything subsequently.)
Belonging society (Max.5)
Approval from Applicant’s Organization / I hereby approve the aforementioned applicant’s application for Sekisui research support.
MM DD, 2014
Address
Organization Name
Name and Position (Signature)
Co-
Researcher / Name / (Signature) / Date of Birth / MM/DD/YY
(Age: )
Organization / Qualifications
Position
Address
Contact Information / TEL: / FAX:
E-mail:
Applicant History (Enter final education, and everything subsequently.)
Belonging society (Max.5)
Approval from Applicant’s Organization / I hereby approve the aforementioned applicant’s application for Sekisui research support.
MM DD, 2014
Address
Organization Name
Name and Position (Signature)
Research Record (Enter the names of latest major papers, theme, journal name, volume, number, and abstract.)
Main Applicant
Co-Researcher
Research Objectives (Enter the research background and objectives, including originality and newness.)
Note: describe the significance of joint and collaboration by researcher from different fields in particular.
Research Implementation Plan (Enter specific research plans and methods to achieve the research objectives.)
Note: describe clearly the specific role of joint(sharing) co-researchers in particular.
Free keywords(Max 7)regarding the research
Desired Amount of Research Support and its Use (Be specific.)
(Unit: JPY)
How did you know about the research support program? / Attendance at Award Ceremony on Oct. 16, 2014
l Website (Sekisui Chemical or another site ( ))
l University office information (e-mail, e-notice board, poster)
l Magazine or newspaper (Name of publication: )
l Other ( ) / Yes / No
Proxy if unable to attend
( )
(Application Precautions)
1. Register online using the website.
Once you have registered online, a confirmation e-mail (with your registration number) will be sent.
(Enter your registration number in the application form. Print your confirmation e-mail and enclose it with your application for research support.)
2. Enter your application for research support using a computer. If there is insufficient space in the application form fields, write “Continued separately” in the relevant field, and attach a separate sheet.
3. If you are a researcher with an organization, make sure to obtain approval from the head of the organization (department head in a university, or head of a faculty, etc.) for each application.
4. Documents and data to be sent by mail. (i.e., cannot be received by fax or e-mail.)
l Write the online reference number to an envelope address side.
l Attach a printout of the online confirmation e-mail (A4) x1.
l (Original) “Application Form for Research Support” signed by the head of your organization x1 (Staple each sheet in the top left corner.) and duplex color copy x12
l Electronic file of the completed “Application Form for Research Support”(CD-ROM, in PDF format)
l General explanation of your research and papers, printed separately, as references for examination up to 3 maximum, x1 each
Further, note that your “Application Form for Research Support” cannot be returned. However, the personal information in your application form will be handled in strict confidence according to Sekisui Chemical’s Privacy Policy.
5. Check that all “Application Form for Research Support” documents have been received.
l We will send a confirmation e-mail within ten days of receipt by mail (or parcel delivery service).
6. The deadline for applications is June 30 (Monday). (All applications MUST arrive by this date.) Note that no arrivals from June 30 onwards can be accepted.
Address:
SEKISUI INTEGRATED RESEARCH, INC.
“SEKISUI CHEMICAL Innovations Inspired by Nature Research Support Program” Office
2-2 Kamichoshi-cho, Kamitoba Minami-ku, Kyoto 601-8105, Japan
Tel: +81-(0)75-662-8604
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