Application Form for 2018 NIG-JOINT (I)

理番号 Application Form for “2018 NIG-JOINT (I)” 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 signature required)

(Last Name) (First Name) Position Title: I hereby apply for the NIG-JOINT (I) －International Joint Research－

１．Applicant for NIG-JOINT Applicant Affiliation Job title Name Address Phone/Fax Number E-mail address

２. The title of research project Title of Joint Research

New or Continuation New / Continuation (from FY year） 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 (I) application is not approved. If you wish to take this option, please fill in “○” mark in the next space.

３．Budget Total Cost of Amount 468,000 Yen (more than200,000 yen up to 500,000 yen） (Estimated amount） Details Fill out the details *Unit Price Number Number * Amount of Visitors of Visits Travel Ex.

Expense Boston, USA – Mishima 156,000 yen 3 1 468,000 yen (156,000×3×1) (Including 4 days /3 nights

daily pay and

accommodation

Application Form for NIG-JOINT (I) 1 / 3 fee.)

Total 468,000 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 (I) 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） Details Fill out the details *Unit Price Number Number * Amount of Visitors of Visits Travel Expense

(Including

daily pay and

accommodation fee.) Total yen

４．Joint Research members（including applicant and NIG researcher） Name Affiliation・Job Denta Mishima ＊＊University, Faculty of ＊＊,Professor Sakiko Sakura ＊＊) Institute, ＊＊Laboratory, Assistant Prof.

５．Details for the Joint Research（Please fill in specifically and briefly）

Application Form for NIG-JOINT (I) 2 / 3 ① Purpose of the Joint Research and expected achievements. Ex. The purpose of this research is ………. As a result of this research, we can expect …….

② Necessity, plan and methods for the Joint Research Ex. Based on ……………., we will develop the method to …………by utilizing …….... efficiently. Specifically, 1. Analysis of ……. 2. Study of …… by using …… 3. Development of ……… system. It is necessary to conduct joint research with your institute for the reason that …… We need to have a meeting with you and utilize …… in your institute to conduct this research successfully.

③ 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 (if yes) Name of NIG Principal Investigator Yes・No recombinant DNA

The usage of Yes・No (If yes) Name of NIG Principal Investigator experimental animals (If yes) Whether animal experiment will be 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. ６．Is this Research supported by any other major grant or funds? Yes ・ No (If yes, please fill in below) Name of Research grant Research project title Amount allocated （Research period）（ ,000yen） Ex. xxxxx(from FY2015-FY2018) 3,000 xxxx Research Grant xxxxx(from FY2017-FY2019) 5,000 xxxx Promotion Foundation

Application Form for NIG-JOINT (I) 3 / 3