【JENESYS Programme】 JSPS Exchange Program for East Asian Young Researchers: THE 6th KAGI 21 INTERNATIONAL SUMMER SCHOOL Kyoto University Active Geosphere Investigations for the 21st Century August 27－September 9, 2011

APPLICATION FORM

■ We do not accept applicants who have participated in the KAGI21 International Summer School before.

1. Contact Information

Last (Family) Name: First and middle names: (Please write your name as written on your passport.) Nationality: (An applicant must possess a nationality of ASEAN countries, India or Japan)

Present position: (Please check one. An applicant must be a master candidate, doctor candidate or postdoctoral researcher who received his/her doctorate degree on or after Aug. 28, 2005.) □ Graduate student (master candidate) □ Graduate student (doctor candidate) □ Postdoctoral researcher

Institution:

Address of Institution:

City: State/Province: Postal code: Country: Telephone: Fax: (Please include country and city codes in telephone & fax numbers.) E-mail address: Home address:

Telephone: (Please include country and city codes in telephone number.)

2. Personal Information

Some items of this section are requested for statistical purposes, and will be kept confidential. Some information is necessary when you need a visa to enter Japan. Age: Date of Birth: Gender: (Month/Day/Year) Country of Birth: Country of Citizenship: Passport Number: Passport Expiration Date: Issued By:

3. Academic Information (Please start from a bachelor degree.) Name of Institution Degree Field Completion Date

4. Previous level of education in: (Please check your level.) Earth science: □ High school level □ Undergraduate level □ Graduate school level Physics: □ High school level □ Undergraduate level □ Graduate school level Mathematics: □ High school level □ Undergraduate level □ Graduate school level

5. Working experience & Current occupation Name of Institution Position From － To

6. English language skills All school activities will be done in English. For that reason, we need to assess your ability to understand and speak English. Are you a native English speaker? (If yes, go to section ７ .) : How many years have you ever taken English courses? :

7. Applicant’s field of Earth Science (Please check one and write your specific field.) □ Geophysics【solid earth】(geodesy, seismology, volcanology, crustal geophysics, etc.)

□ Geophysics【fluid earth】(meteorology, oceanography, hydrology, geomagnetism, etc.)

□ Geology and Mineralogy (geology, mineralogy, geotectonics, paleontology, geomorphology, etc.)

Specific field:

8. Applicant’s statement of reasons for wanting to attend school 9. Subject of past research and Achievements

10. List of major publications Authors (all), Title, Journal, Vol., No., pp. - , Month, Year 11. Poster title (If you can present your current research as a poster at the summer school, please write its title.)

12. Statement by the applicant’s supervisor or senior colleague (This section should be completed by the applicant’s research supervisor or senior colleague. Please comment on the applicant’s academic or professional abilities.)

Name of person completing section 12: Position: Institution: Telephone: Fax: (Please include country and city codes for telephone & fax numbers.) E-mail address:

Send the completed application form by email to: [email protected]

Application Deadline: July 5, 2011

KAGI 21 International Summer School Secretariat Division of Earth and Planetary Sciences, Graduate School of Science Kyoto University, Kyoto, 606-8502, JAPAN