GSDM Program Application Form for Long-Term Overseas Travel Support

GSDM Program Application Form for Long-term Overseas Travel Support

※Check □ in the right column, if you are applying for International Project. □

Submission Date： YY MM DD

Name of Applicant / （Master・Doctor X year）
Client Code（Required）
Student ID Number / GSDM ID
Contact / E-mail:
Extension: Mobile Phone：
Affiliation / Department Laboratory
Name of Supervisor, E-mail
Supervisor’s comment / （Signature or Seal）
Name of host institution
Title of your international project at the host institution
Framework of this international project
·  How did you come to this particular international project at this specific host institution?
( )
·  Have you and/or your lab ever collaborated with the host institution? Yes / No
o  If so, please provide a description of the nature of collaboration so far.
( )
·  Does your lab have an official collaboration agreement with the host institution? Yes / No
o  If so, please illustrate its terms and identify whether there are descriptions about IPR.
( )
·  Is there anything which has been agreed informally between your lab and the host institution, albeit it has not been included in the formal agreement? Yes / No
( )
·  Is there anything which has yet to be discussed and agreed between your lab and the host institution? Yes / No
( )
Explanation about International Joint Research or International Internship (about 500 words in total)
1.Summary of Project
(1)Nature of project / □ Joint research □ Internship
(2)Duration of stay
(3)Purpose of project
(4)Features and research methodology
(5)Funding plan (* Funds to support research and living during overseas stay)
(6)Status of preparation
(7)Schedule (Milestone) / Month / Month / Month / After returning home
Task
Task
Task
(8）Expected results
2. Explain the relationship between your PhD dissertation and the international project.
3. Describe the status of your PhD work during the international project.
4. How does your international project relate to the learning outcomes of GSDM (interdisciplinary research, development of leadership and communication skills)? Has the choice of your project been influenced by attending the GSDM program. If so, illustrate how.
Other, special remarks

Signature of Applicant：

Required documents

□ In the case of international joint research, a document showing the conditions for acceptance by the accepting institution.

□ In the case of international internship, an acceptance letter from the accepting institution

□ Airfare estimate

Itinerary (briefly） / MM DD（ ） / Depart Japan
MM DD（ ） / Arrival at Destination
MM DD（ ）～ MM DD（ ） / Schedule of joint research/internship, etc.
MM DD（ ）～MM DD（ ） / Other visit（name of institution to be visited）
MM DD / Depart from Destination
MM DD / Arrival in Japan
Travel expense estimate / Remarks
Air ticket price / yen / Attach estimate by a travel agency
Rough estimate of accommodation charges / nights× yen＝ / Specify the exchange rate used
Daily allowance / yen / （Calculation details）¥3,000x days,
\1,500x days, total \
Transportation expense to the airport / Round trip yen / For Narita Airport, \3,020 one way; for Haneda Airport, \650 one way
Other / yen / （content in detail, such as visa expenses）
Total / yen