整理番号

整理番号 Application Form for “2018 NIG-JOINT (B)” National Institute of Genetics Research Organization of Information and Systems Date: To the Director-General, National institute of Genetics, Research Organization of Information and Systems (For the following box, please fill in for only Japanese Institution. Keep it blank for non-Japanese Institution.) Name of Administrator of Institution you belong to (No seal required.) (Last Name) (First Name) Position Title: I hereby apply for the NIG-JOINT (B) ,,Applicant for NIG-JOINT Affiliation Job title Name Applicant Address Phone/Fax Number E-mail address ,. The title of research project Title of Joint Research New / Continuation (from FY year， In case of “continuation”, your project was accepted as ?Collaborative(A) or New or Continuation ?Collaborative(B) in previous fiscal year. (Please check the appropriate box.) Period of Research Date: April 1st, 2018 ， March 31st, 2019 Name of NIG representative As an option, you can simultaneously apply for“NIG-JOINT (A)”, in case where (B) application is not approved. If you wish to take this option, please fill in “?” mark in the next space. ,,Total Budget (Up to 1 million JPY : total amount of travel and Total Cost of Amount research expenses) 922,000yen (Estimated amount) ※It must be equal to the “Total Cost of Amount” in “#6. Detailed description of necessary expense.” Application Form for NIG-JOINT (B) 1/4 ,Please fill in specifically and briefly, ,,Details for the Joint Research * When columns are too short, you can extend them electronically. ?Purpose of the Joint Research and expected achievements. (In case of continuing project, please state your major achievements in previous fiscal year and the reason for continuation.) Ex. The purpose of this research is to figure out .................... We will conduct .............. to accomplish this purpose. The achievements expected from this research are ........................................................................ ............................................................................................................................................................................................. ............................................................................................................................................................................................ ? Necessity, plan and methods for the Joint Research Ex. The reasons for conducting joint research with Prof. ............ in your institute are as follows. 1. By taking advantage of his achievement, we can expect .................. 2. We need to have a meeting with you and utilize ........ in your institute to conduct this research successfully. .............................................................................................................................................................................................. ............................................................................................................................................................................................... The research plans are as follows. 1. Obtain........ from................. 2. Derive..........from............... to figure out ........ in full detail. 3. Determine ........ by conducting. ......................... 4. Study on ....... with obtained ................. 5. Build a database of .................. We hereby apply for the joint research with your ..... laboratory to conduct this research as described above. ............................................................................................................................................................................................. ............................................................................................................................................................................................ ?Others (additional request for the Joint Research, if any.) Ex. We would like to bring our graduate student who is actually carrying out this research to the meeting. The experiments of Yes?No (if yes) Name of NIG Principal Investigator recombinant DNA The usage of (if yes) Name of NIG Principal Investigator experimental Yes?No (if yes) Whether animal experiment will be animals Yes ? No conducted by outside researcher or not. Use of isotope Yes?No ※The person in charge of the experiment must be a NIG researcher. ※If any of animal experiments are directly conducted by outside researchers, they are required to apply for NIG qualification screening and undergo a training. Application Form for NIG-JOINT (B) 2/4 ,including applicant and NIG researcher, ,,Joint Research members *When columns are too short, you can extend them electronically. Affiliation?Job Name Denta Mishima **University, **laboratory, Professor Sakiko Sakura **Institute, ** Laboratory, Assistant Prof. ) ,,Detailed description of necessary expense ，Number of visit must be more than 7 days in total during the research period， Number Number Details Fill out the details *Unit Price *Amount of Visitors of Visits Ex Travel Tokyo,Mishima, Single -day 11,540 yen 2 6 139,000 yen Expense (11,540×2×6) (including Tokyo,Mishima, Overnight 16,540 yen 1 2 33,080 yen daily pay and (16,540×1×2) accommodation fee.) Subtotal 172,000 yen (Supplies,equipments etc…) Ex. Experimental Animal 200,000 yen Research Laboratory Instrument 250,000 yen Expense Chemicals 300,000 yen Subtotal 750,000 yen ※Total Cost of Amount (Up to 1 million JPY) 922,000 yen * “Unit Price”,Please fill in the sum of round trip fare, accommodation fee (2,500JPY/night), and daily pay (faculty members and researchers:2,500JPY/day, Students:1,500JPY/day). As a general rule, you need to stay at the guest house on our premises. * “ Amount”:Please fill in the sum of “Unit Price” by “Number of Visitors” by ”Number of Visits”. * If visiting by airplane, travel fee between Narita Airport and JR Mishima station is 6,990 yen (one-way) and Haneda Airport and JR Mishima station is 4,930 yen (one-way). You can simultaneously apply for “NIG-JOINT (A)”, in case where (B) application is not approved. If you wish to take this option, please fill in your budget (up to 200,000 JPY) below. Total Cost of Amount ,000 Yen ( Up to 200,000 yen， (Estimated amount， Number Number Details Fill out the details *Unit Price * Amount of Visitors of Visits Travel Expense (Including daily pay and accommodation fee.) Total yen Application Form for NIG-JOINT (B) 3/4 ;,Is this Research supported by any other major grant of funds? Yes ? No (If yes, please fill in below) Research project title Amount allocated Name of Research grant ，Research period， ， ,000yen， Ex) xxxx Research Grant xxxxx(from FY2015-FY2018) 3,000 xxxx Promotion Foundation xxxxx(from FY2017-FY2019) 4,500 ,. Research Achievements of the Applicant (Please fill in the achievement related to this Research Project) Publication Date Title (Papers in press etc…) Ex. Ex yy/mm 1. Title of Essay ????、 ××××、???? (No. of other authors. Your order) Science vol.**, issue **, pp.51-58 (2010) yy/mm 2. ,,, yy/mm 3. ,,, , Research profile of the Applicant Ex. yy/mm Ph.D... Faculty of Life Science, ??University yy/mm – yy/mm JSPS Research Fellow (××Laboratory, Graduate School of ××University) (Title of Research Subject) yy/mm Research Assistant, Faculty of ××, ××University (Research Area, etc.) yy/mm Associate Professor, ××University, Up to present Application Form for NIG-JOINT (B) 4/4