Tohoku University Global COE Program:

“World Center of Education and Research for Trans-disciplinary Flow Dynamics”

APPLICATION FOR INTERNATIONAL INTERNSHIP PROGRAM FOR FOREIGN STUDENT

1.  Name in FULL
FAMILY First Middle / Birthday:
/ /
(Month) (Day) (Year) / Chinese Character if you have
2.  Current Position:
Name of University
Faculty and Department
Academic year (Doctoral course 1st / 2nd / 3rd ) / 3. Sex
M F
4. Current Supervisor’s Name
5. Research Topic in your University
6. Expecting Research Topic in International Internship Program
7. Name of the accepting Supervisor at Tohoku University and his/her Current Position.
Name of the Co-host supervisor at Tohoku University and his/her Current Position.
If applicants choose his/her host supervisor other than a member of the Global COE, the applicant should consult the host supervisor in order to select a co-host supervisor who is a member of Tohoku University Global COE “World Center of Education and Research for Trans-disciplinary Flow Dynamics”.
8. Period of Stay ( / / through / / )
9. What do you expect from International Internship Program?
(Also please fill in page 3 to show your concrete research plan.)
10. Name of the liaison office if you are applying through it.
11. Nationality/Permanent Residence
12. Academic Degree if you have
Type / Date Obtained
/ /
(Expected) Day Month Year
Field
Institute (Country)
13. Education and Employment
Name of University /Institute, etc. / Degree or Position / From - to
14.Academic Awards(Please indicate title and year)
15. Subject and Achievement of Past Research
16. Language Ability (Evaluate your ability using excellent, good and fair.)
Writing / Reading / Speaking/Hearing
Japanese
English
17. Past Stay(s) in Japan
Place: Year: Purpose:
18. Mailing address
1)  Office:
Tel:
Fax:
E-mail: / 2)  Home:
Tel:
Fax:
E-mail:

I agree with the conditions written in the 2012 Application Guideline and certify the above information to be accurate and correct.

Date:

Signature:

Please describe your concrete research plan
Arrival - 2nd Week
3nd - 4th Week
5th – 6th Week
7th – 8th Week
9th – 10th Week
11th – 12th Week
13th – 14th Week
15th –1 6th Week
17th – 18th Week
19th – 20th Week
21h – 22th Week
23th – 24th Week
25th Week –

International Internship Program

Research Plan

Name:

Internship Period: (M) / (D) / through / /

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