ࡱ> y RbjbjO{{Wcccccwww8wh://EEE9999999$$=?\99c9ccEET":U"U"U"cEcE8U"9U"U"/m1EP!p088:0h:02@2@0m1m12@c1XU"99wh:2@ ): The 22nd Winter Institute Program APPLICATION FORM Name (in English) *As appeared on passportFirst Last Attach 4 cm x 3 cm photograph taken within past 6 months. *Write your name in alphabet on the back photo *Must wear glasses on photo if you wear it oftenName (in "oW[/Kanji)First Last NationalitySex[ ] Male [ ] FemaleDate of BirthDD MONTH YYYY (e.g. 07 DEC 1980) Home Address (postal code)Home phone number+82-Mobile phone number+82- Staff in Japan may contact you to your mobile phone.e-mail Staff in Japan may contact you to your e-mail address. Also this e-mail address will be used during WI period in Japan.Home UniversityDepartment *Type same department as CERTIFICATE OF REGISTRATION/ATTENDANCE shows.Major *Type same major as CERTIFICATE OF REGISTRATION/ATTENDANCE shows.Current academic yearM1 [ ]M2 [ ]D1 [ ]D2 [ ]D3 [ ]D4 [ ]D5 [ ]LaboratoryAddress (postal code) Official letter of acceptance will be sent to your laboratory address.Phone number+82- Staff in Japan may contact you to your laboratory phone numberFAX number +82- Staff in Japan may contact you to your laboratory FAX numberSupervisory professor details[ ]Male [ ]FemaleFirst name Last name Phone+82-e-mailAcademic/Working Background Name of UniversityFromToDiploma/ Degree awardedMajor(e.g.) ABC UniversityMAR 2005FEB 2009BachelorArchitectural Engineering(e.g.) XYZ co. LtdMAR 2009FEB 2010--(e.g.) YYY UniversityMAR 2011PresentMasterArchitectural Engineering    1. Describe your motivation applying to this program. (Please fill below at least 80% or more.) 2. Describe your current research at your university. (Please fill below at least 80% or more.)  3. List 1st to 3rd research theme that you want to carry out in Winter Institute. (Only 1 theme will be picked and carried out during program)1st2nd3rd 4. List 1st to 3rd host institute and its details that you want to be placed.1st Institute nameLaboratory nameResearchers name (if possible)Mr./Ms.Laboratory address Phone number (if possible)+81-2nd Institute nameLaboratory nameResearchers name (if possible)Mr./Ms.Laboratory address Phone number (if possible)+81-3rd Institute nameLaboratory nameResearchers name (if possible)Mr./Ms.Laboratory address Phone number (if possible)+81-*If you have invitation letter or any approval letter from your host researcher (E-mail or FAX is accepted), please write 1st Institute name and its details only. 5. List any significant publications you have written in the past. 1. Title of thesis in Master course2. Title of thesis in Doctor course3.Report in journal 4. Oral presentation in academic conference5. book6. patent7. Award*Please DO NOT attach any thesis. 6-1. Levels of English and Japanese Languages (e.g. Excellent, Good, Fair or Poor )LanguageSpeakingListeningWritingReadingENGLISHJAPANESEOTHER ( )English: Excellent (TOEIC 730-990), Good (TOEIC 725-600), Fair(TOEIC 595-500), Poor Japanese: Excellent (JPLT1), Good (JPLT2), Fair(JPLT3), Poor 6-2. Please fill in length of English language or Japanese language study.English: yearsJapanese: yearsOther( ) years 6-3. Specify qualification details below. (Expired TOEIC or TOEFL score is accepted)e.g.Qualification/ test nameTOEICGrade/ Score730YearJan. 20081Qualification/ test nameGrade/ ScoreYear2Qualification/ test nameGrade/ ScoreYear3Qualification/ test nameGrade/ ScoreYear4Qualification/ test nameGrade/ ScoreYearNote: A copy of each certificate must be attached to prove your grade or score.7. Enter if you have more than 1 month of experience of living, study or training abroad. (DO NOT include traveling or conference.)e.g.CountryUKPurposeStudyDurationMar 1998-Dec 20011CountryPurposeDuration2CountryPurposeDuration3CountryPurposeDuration4CountryPurposeDuration 8. Have you ever been in Japan before? (Including Traveling) [ ] Yes (Number of visiting: times, Purpose: ) [ ] No 9. Applicant signature I certify that the information disclosed in this application is true to the best of my knowledge and I read and agreed the terms and condition of the Winter Institute. 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