Please note: The Japanese language version is the authentic copy and should be referred to when questions arise about the English language version.

Academic Year 2016Application for

TheGraduate Program for Leaders in Life Innovation (GPLLI),

ALeadingGraduateSchool Doctoral Program

1. Applicant information

Name in full / Male / Female
Nationality
Date of birth
Academic record / Graduated in _____ (month) , ______(year) from:
______
(department, faculty, university)
Enrolled or will enroll in ____(month) , _____(year) in:
Dept. of (Master/Doctor) ,
Graduate School of , the University of Tokyo
Personal address / Postal code:
Phone number: E-mail address:
Current Affiliation / Department of ______, Graduate School of ______,
(University)
(Name of research center or institute: ______)
University address / Postal code:
Phone number: E-mail address:
Student information(circle applicable as of December 1, 2012) / The first year Master student at UT Students ID: ______
Prospective student for Doctor of Medicine / Doctor of Pharmacology (Four year course) prospective enrolled studentat UT
Supervisor or
supervisor-to-be
at UT / Affiliation / Full name
Do you receive scholarship loans from JSPS? / Yes/No / Do you receive any scholarship for foreign students? / Name of scholarship:
______
Period of participation:
Per month: _____ 0,000 yen
Application/acceptance status for DC in the JSPS Research Fellowship for Young Scientists (circle one) / 1. Accepted 2. Waitlisted 3. Rejected
4. Planning to apply 5. Not applicable
Acceptance status for other fellowships, such as the RIKEN Junior Research Associate program for graduate students / 1. Accepted
2. Waitlisted
3. Currently applying
4. Not applicable / (If 1. or 2.)
Name of fellowship:
______
Period of participation:
Per month: _____ 0,000 yen
Check this box if you wish to apply as a non-grantee course student, either because you have already been accepted as a JSPS Fellow or for some other reason, such as dependent exemption concerns / □I choose not to receive
the GPLLI grant.
Comments (plan to study abroad, plan to study at other institutions, and so on)
Research topic

2. Research Proposal(You may include figures. All text must be in a 10-pt or larger font.
Do not alter the format or add another page. (These rules apply to all of the following forms.))

(1)Describe your research background and current problems, with references provided as appropriate.

(2)State your research goals, methods, and target of study.

(3)Explain the defining characteristics of your research, what makes it original, and what academic impacts it will have that are applicable to medical care and industry, etc. when it is completed.

(4)Give details on your plans, including what you intend to uncover and to what extent.

Name of applicant:

(Research Plans continued)
Timeline for your plan:
(First year)
(Second year)
(Third year onward)

Name of applicant:

3. My Motivations for Applying to the GPLLI Program and my Visions for my Future Career

State why you wish to apply to this Leading Graduate School Doctoral Program, and what you plan for your career (industry, academia, government office etc.)after graduating from the PhD program. (Make references to how you aspire to contribute to the sustainable development of human society through your future career, from the point of view of life and health.) Also provide your self-assessments on your experiences as a leader, strengths and achievements of special note (e.g. research presentations, exceptional academic achievements, awards, experience studying abroad, distinctive off-campus activities).

Name of applicant:

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Please note: The Japanese language version is the authentic copy and should be referred to when questions arise about the English language version.

4. Research background

(1) Describe your research up to the present. You may include your graduation project, and studies equivalent to projects (e.g. special experiments, theoretical exercises).

For the following categories, you must list only those works in which you played a central role. List each item with a running number, and state "Non applicable" for a category for which you have nothing to list.Underline the name of the applicant.

(2) Papers published in academic journals and books (you may list only those works which have been printed or already been accepted for publication. Divide your list into reviewed and non-reviewed publications.)

For each item, you must list the names of all authors (including the applicant, in the same order as in the paper; you may omit part of the list of names by substituting them with "and __ others" if there are many co-authors), your paper title, name of the journal, publisher, volume and issue, page numbers, and year of publication, in this order. For papers already accepted but not yet published, you must attach documents verifying the acceptance of these papers.

(3) Presentations given at conferences and symposium, both domestic and international (Divide your list into oral and poster, as well as reviewed and non-reviewed, and mark them accordingly.)

List only those presentations that have been given by the applicant themselves. For each item, you should provide the names of all authors (including the applicant, in the same order as at the time of the presentation; you may omit part of the list of names by substituting them with "and __ others" if there are many co-authors), the title, the name of the conference, the identification number for your paper, location, and month and year of your presentation. (Presentations planned for the future should be excluded, except in cases where your submissions have already been accepted. In such a case, you must attach a document verifying the acceptance of these papers.)

(4) Other (e.g. awards, TOEFL, TOEIC, EIKEN score)

Name of applicant:

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Please note: The Japanese language version is the authentic copy and should be referred to when questions arise about the English language version.

Letter of Opinion on the Applicant for the LeadingGraduateSchool Doctoral Program

This page must be completed by the applicant's supervisor (or supervisor-to-be) at the University of Tokyo,

and sealed in an A4-size envelope.

(The name and affiliation of the applicant should be clearly written on the envelope.)

1. Name of applicant
2. Research topic (Copied from the "Research topic" section in the application form)
3. Assessment of applicant
4. Overall assessment
Judge the overall research capacity of the applicant and the aptitude for the program. Circle one of the four categories that apply, as well as rank how strongly you recommend this student. / (1) Among the ______graduate students I have supervised, the applicant ranks
a. Within the top 10 %
b. In the top 25 %
c. In the top 50 %
d. Lower than the top 50 %
(2) Of the _____ students in the same year that I am recommending, this applicant ranks _____ in place.

Letter writer:Graduate school of ______/ Institute of ______The University of Tokyo

Academic appointment: ______

Full name: ______(Seal/Signature)

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