Research Center for Korean Studies (RCKS) KyushuUniversity

6-10-1 Hakozaki, Higashi-ku, Fukuoka 812-8581, Japan

Tel.: +81-92-642-4358 Fax: +81-92-642-4359 E-mail:

Visiting Professor Program

Application Form, 2015-2016

A complete and accurate response will facilitate our review. Please type or print, and fill in all blanks.

1.Name in full:

______

(Surname) (First or Given Name) (Middle Name)

Sex: Male /Female(circle one)

2.Present address:

Home:

______

Tel.: Fax.Mobile Phone

Office:______

______

Tel.: Fax.E-mail:

URL:

Please indicate which address you prefer to use for our correspondence: Home /Office

3.Date of Birth:______

(Day) (Month) (Year)

Place of Birth:______

(City) (Country)

4.Citizenship:

5.Have you ever applied to this fellowship program before?

Yes / No If yes, in what years?

6.Present affiliation and status

Affiliation or place of work:

Status:

  1. Highest academic degree you have acquired:

______

(Type of degree) (Name of degree-granting institution) (Year)

8. Discipline and field of specialization:

(a)Scientific discipline (history, political science, geography etc.):

(b)Field of specialization (e.g. 19th century Korean history, political participation economic geography.):

9. Recent subject of research:

10.Title and a brief description of the project you wish to undertake at the RCKS:

(a) Title:

(b) Description:

11.______Education and academic training (Please specify in chronological order, giving all essential dates, beginning with graduation from university and ending with the highest degree):

12.Professional career (Please specify in chronological order, beginning with the present, giving all essential dates):

13.Other occupations for the period not covered in the sections on academic training and professional career:

14.Publications / Writings (List of books, articles, and other writings with complete publication data which you deem as your most important contributions to scholarship. Please limit to 10 items):

15.Please cite any academic honors received, including major fellowships or other awards:

16.Languages

(a) What language would you use at the RCKS?

(b) In what language would you contribute an article tothe RCKS international referred journal?

(c) In what other relevant languages are you proficient?

17.Names of persons whom you asked to write letters of reference:

______

______

(Name) (Status) (Affiliation)

18.You would be obliged to stay in Fukuokabasically at least 3 months during the period from April 1, 2015 to March 31, 2016. Which exact period would you prefer to stay in Fukuoka?

From , to , ( Months)

(Day & Month) (Year) (Day & Month) (Year)

19.Experience of staying in Japan Yes / No

If yes, please describe the period of stay______

20.Possibility and number of accompanied persons during your stay in Fukuoka Yes/No

If yes, how many will be accompanied? ______

* * *

I declare herewith that the above is true and correct to the best of my knowledge.

______

(Place) (Date) (Signature)

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