FORMAT 2 – Standard　		          		　　　		
 JSPS International Fellowships for Research in Japan
APPLICATION FORM FOR JSPS POSTDOCTORAL FELLOWSHIP FOR RESEARCH IN JAPAN (APPLICATION THROUGH AN OVERSEAS NOMINATING AUTHORITY)
FY 2017
< Application should be typed. >
1. Name in Full	2. Date of Birth	

/	
	
/	
   	
FAMILY　　　　　　　　　 First　　　　　　　　　　　  Middle	  　Day       Month    Year	
3. Nationality/Citizenship	4. Permanent Resident	5. Sex	

※If you have Japanese nationality, you’re not
 eligible to apply.		Male / Female	
6. Current Appointment and/ or Status	
Title: 		
Division:		
Institution:		
7. Academic Degree ( PhD, or an equivalent)	
Type:		Date Obtained (or Expected)	
Field:		  	/		/	  	
Institute:		Country:	Day     Month    Year	
8. Higher Education (Start from the latest one)	
Name of University / Institution	Location	Degree	Field	Completion Date (Month/Year)	

					
					
9. Employment (Start from the latest one)	
Name of Institution	Location	Position	From – To
(Month/Year)	

				
10. Academic Awards (Please indicate title, year and conferrer.)	

	
11. Field of Specialization　	
	
12. Name of Proposed Host Researcher and Host Institution	
Host researcher: 		
Title:		
Division:		
Host Institution:		
13. Research Theme in Japan (must be around 100 letters including spaces and symbols)	

14. Proposed Tenure of JSPS Fellowship (Start of tenure: 1 Apr.2017-30 Nov.2017, Total: 12-24months)	
From:		/		/		to		/		/		Total:		
Day     Month      Year                Day     Month      Year                    　　　Months	
15. Past Research and Achievements 

16. List of Major Publications
Authors (all,) Title, Journal, Vol, No., pp.-, Month, Year

	
17. Research Plan in Japan: Please include at least the following items:
a. Background of proposed research plan
 b. Purpose of proposed research
  c. Proposed Plan
  d. Expected results and impacts

18. Research Plan in Japan (Continued)

19. Language Ability (5: excellent ………1: poor)	
	Reading　　　　　	Writing	Understanding	Speaking　　　　	
Japanese	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	
English	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	
	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	
	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	
	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	□5 □4 □3 □2 □1	
20. Past Stay(s) in Japan	
Place:	Year:	Purpose:	
 　			

21. Name(s) of other fellowship(s) for which you are now applying	
□N/A
□JSPS Postdoctoral Fellowship (Short-term)
□JSPS Postdoctoral Fellowship (Standard) 
□JSPS Postdoctoral Fellowship (Short-term) application through overseas nominating authorities
□Other fellowships (                                                                         )	
22. Mailing Addresses (Approximately three months after receiving an application, JSPS will send out fellowship-commencement documents, so care should be taken to ensure that the address will remain valid. Please check Office or Home; unless otherwise stated we will send the documents to your Office.）	
□Office:

	□Home:

	
Tel:	Tel:	
Fax:	Fax:	
E-mail:	E-mail:	
23. If you have been previously awarded as a JSPS fellowship or participated in another JSPS research program, please indicate the name of the program and the period of your participation.
□  I have been awarded a fellowship under the JSPS Postdoctoral Fellowship Program for North American and European Researchers for the period of
(Day / Month / Year) to (Day / Month / Year).

□　I have been awarded a fellowship under the JSPS Summer Program in (Year).

□ Other Program
    Name of the program:
    Period of participation:	
I certify the above information to be accurate and correct.

Date:　　　　　　　　　　　　　　　　　　　　　　　　　　　

NAME (Print):                                              

Signature:　　　　　　　　　　　　　　　　　　　　　　　　　
(Applicant signature)

NOTE:
The following documents must be attached.
1)	A letter of acceptance/invitation from the candidate’s prospective host researcher in Japan, stating that s/he accepts the candidate at his/her institution.
2)	A letter of reference/recommendation from the candidate’s current or previous supervisor (not from his/her prospective host researcher in Japan). Please use referee report template provided by the Australian Academy of Science.
3)	A copy of the candidate’s PhD degree diploma. If the degree has not yet been awarded, a letter is required from the candidate’s institution stating the date that he / she will officially receive the degree.　In that case, the candidate should submit to JSPS the original of the degree certificate or copy of the diploma promptly before starting his/her fellowship.
4)	Supplementary documents (If necessary)
5)	The application form submitted must be the original. PDF files are also acceptable.
6)	All documents must be in either English or Japanese. When the original document is in another language, please be sure to attach an English translation (which does not need to be an official translation, but may be done by the host or candidate.)
7)	Image data of candidate’s signature pasted on the form is acceptable.