ࡱ>  R bjbj]W]WB?=?= .% +++8cO+[T:"UUURRRRRRR$VGYNSUUUUUS`TU^RUR~ININK4R+T0[TKpYeYhNYNUUUUUUUSSUUUUUUUYUUUUUUUUU + : The Long-Term Internship Program FY20153rd Term for DC Application Form Name of ApplicantFaculty / Department / School YearDate of Birth (Month / Day / Year)SexNationalityMale / FemalePresent AddressZip Code: Tel00 000 000000000e-mail00000000 Another contact number to reach you on campus during the daytimeAcademic Background ; Please fill in your subject information after graduating from universities. Please add rows as necessary.Name of SchoolDate of Graduation (Month / Year)UndergraduateGraduateGraduateLanguageNative LanguageSecond Language with proficiency at or above conversation-level Language Qualification/ Score (EIKEN, TOEIC, etc) (Month/Year)For foreign students, please provide details of your status. (under any national programs, government-sponsored, etc.)  (Month/Year)Grant InformationAre you receiving any grant? Yes / NoPlease provide details of the grant as well as your duties where applicable RA0TA0JSTPS Research Fellowship for Young Scientists, etc. Experience / Achievement of Joint-research with Corporates, etc.Please provide details of the respective roles and responsibilities of the company and the Applicant in the joint research. Please write down  none below if you have no joint research experience. Internship ExperiencePlease provide details of the host organization(s)/institution(s), the period of the internship, and the job description.  0Ambition for the Long-Term Internship Please describe your ambition for the long-term internship, in line with its objectives, with a focus on the following four points. (less than 500 words) Motives for applying (e.g. How youre planning to leverage the internship experience in your future career path. Desired host organizations/institutions or the desired field (if fixed in your mind) and the reason behind. Skills / knowledge you are aiming to obtain through the internship experience Career aspiration post the internship 0Research Summary up to date Please describe your research to date, focusing on the research contents, the background, the characteristics unique to the research and the current progress, with less than 250 words in plain and brief language. (You can attach graphs/charts) 0Research Achievementas Reference Please describe the achievement of the Applicant s research, following the below listed items in a consecutive manner. Please write  None. under the items not applicable. Please make the Applicant s name of each research bold and underlined. Dissertation and writing works published in academic journals, etc. (including bulletins / collection of papers). Please clearly state whether they are peer-reviewed or not. If such dissertation/writing works are to be peer-reviewed, please list up only those already printed and determined to be published. Please provide details of the dissertations/writing works in the following order; authors (Please write down all the authors including the Applicant in the same order as they appear in the publication), the titles of the dissertations/writing works, the names of the journals, the volume/issue numbers, the first and last page numbers of the dissertations/writing works and the year of publication. Same information needs to be provided for the below (2) as well. In case such dissertation/writing works are determined to be published but with no page numbers etc. issued yet, please attach documents to prove the determination. Reviews or explanatory notes in academic journals or business magazines (only those already published) Presentations at international conferences (please list those already presented, with clear segregation of oral or poster presentations as well as with or without peer-review.), authors (all the authors including the Applicant in the same order as they appear in the publication), the titles of the presentation, the name/venue and date (month and year) of the conference where the paper was presented. Please mark the presenter in the list. Presentations at conferences/symposiums, etc. in Japan (The same list of information as the above (3) needs to be provided.) Patents, etc. (please specify the publication or acquisition of the patent.) Others (awards received, etc.) Date: _________________ Letter of Recommendation for Long-Term Internship Program FY2015 (3rd Term) Applicant (DC) I fully understand the objectives of the Program for the Practical Training and Engagement of Innovators and herby recommend the person named below as the candidate for the subject Long-Term Internship Program. (Name of the Candidate) (Signature) 0000000000000000000000000000 Name: Title: Organization/Department Contact Information (TEL/E-mail): 0 Your relationship to the Applicant Please describe below the applicants research attitude, research progress, subject knowledge/skills, and other competencies, such as inventiveness/creativity, communication skills, leadership, etc. What is the significance of this long-term internship experience to the Applicant? Note: Letter of Recommendation needs to be completed within one page and sealed up tightly for submission. The Long-Term Internship Program FY20153rd Term for PD Application Form Name of ApplicantFaculty / Department / School YearDate of Birth (Month / Day / Year)SexNationalityMale / FemalePresent AddressZip Code: Tel.00 000 000000000e-mail00000000 Another contact number to reach you on campus during the daytimeAcademic Background ; Please fill in your subject information after graduating from universities. Please add rows as necessary.Name of SchoolDate of Graduation (Month / Year)UndergraduateGraduateGraduateDoctorate Degree Granted in __________________________ (Area of Study) on ________________________(Month/Year)LanguageNative LanguageSecond Language with proficiency at or above conversation-level Language Qualification/ Score (EIKEN, TOEIC, etc.) (Month/Year)For foreign students, please provide details of your status. (under any national programs, government-sponsored, etc.)  (Month/Year)Grant InformationAre you receiving any grant? Yes / NoPlease provide details of the grant as well as your duties where applicable RA0TA0JSTPS Research Fellowship for Young Scientists, etc. Experience / Achievement of Joint-research with Corporates, etc.Please provide details of the respective roles and responsibilities of the company and the Applicant in the joint research. Please write down none below if you have no joint research experience. Internship ExperiencePlease provide details of the host organization(s)/institution(s), the period of the internship, and the job description.  0Ambition for the Long-Term Internship Please describe your ambition for the long-term internship, in line with its objectives, with a focus on the following four points. (less than 500 words) Motives for applying (e.g. How you re planning to leverage the internship experience in your future career path. Desired host organizations/institutions or the desired field if fixed in your mind and the reason behind. Skills / knowledge you are aiming to obtain through the internship experience Career aspiration post the internship 0Research Summary up to date Please describe your research to date, focusing on the research contents, the background, the characteristics unique to the research and the current progress, with less than 250 words in plain and brief language. (You can attach graphs/charts) 0Research Achievementas Reference Please describe the achievement of the Applicant s research, following the below listed items in a consecutive manner. Please write  None. under the items not applicable. 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Dissertation and writing works published in academic journals, etc. (including bulletins / collection of papers). Please clearly state whether they are peer-reviewed or not. If such dissertation/writing works are to be peer-reviewed, please list up only those already printed and determined to be published. Please provide details of the dissertations/writing works in the following order; authors (Please write down all the authors including the Applicant in the same order as they appear in the publication), the titles of the dissertations/writing works, the names of the journals, the volume/issue numbers, the first and last page numbers of the dissertations/writing works and the year of publication. Same information needs to be provided for the below (2) as well. In case such dissertation/writing works are determined to be published but with no page numbers etc. issued yet, please attach documents to prove the determination. Reviews or explanatory notes in academic journals or business magazines (only those already published) Presentations at international conferences (please list those already presented, with clear segregation of oral or poster presentations as well as with or without peer-review.), authors (all the authors including the Applicant in the same order as they appear in he publication), the titles of the presentation, the name/venue and date (month and year) of the conference where the paper was presented. Please mark the presenter in the list. Presentations at conferences/symposiums in Japan (The same list of information as the above (3) needs to be provided.) Patents, etc. (please specify the publication or acquisition of the patent.) Others (awards received, etc.) Date: _________________ Letter of Recommendation for Long-Term Internship Program FY2015 (3rd Term) Applicant (PD) I fully understand the objectives of the Program for the Practical Training and Engagement of Innovators and herby recommend the person named below as the candidate for the subject Long-Term Internship Program. (Name of the Candidate) (Signature) 0000000000000000000000000000 Name: Title: Organization/Department Contact Information (TEL/E-mail): 0 Your relationship to the Applicant Please describe below the applicant s research attitude, research progress, subject knowledge/skills, and other competencies, such as inventiveness/creativity, communication skills, leadership, etc. What is the significance of this long-term internship experience to the Applicant? Note: Letter of Recommendation needs to be completed within one page and sealed up tightly for submission. 0Only applicable to Collaborative Organizations0 Letter of Consent To President of Hiroshima University With regards to the Long-Term Internship Program participation by __(Name of the Applicant)__, I hereby consent to the following conditions: Conditions The subject Applicant ( the Applicant ) will take the class  Long-Term Internship, the Common Subject of Graduate School in Hiroshima University, in case he or she is a doctoral student (excluding the master s program). In case the Applicant is a doctoral student (excluding the master s program), we, as the university he or she belongs to, will enroll him or her into the Personal Accident Insurance for Students Pursuing Education and Research ( PAS ) and the Liability Insurance for Students Pursuing Education and Research ( LSR ) on our own responsibility. We will conclude, after consultation, the Memorandum and the Internship Description relating to the Internship under the Program for the Practical Training and Engagement of Innovators with Hiroshima University and the host organization. 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