<p> 【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</p><p>APPLICATION FORM</p><p>■ We do not accept applicants who have participated in the KAGI21 International Summer School before.</p><p>1. Contact Information</p><p>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)</p><p>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</p><p>Institution: </p><p>Address of Institution: </p><p>City: State/Province: Postal code: Country: Telephone: Fax: (Please include country and city codes in telephone & fax numbers.) E-mail address: Home address: </p><p>Telephone: (Please include country and city codes in telephone number.)</p><p>2. Personal Information</p><p>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: </p><p>3. Academic Information (Please start from a bachelor degree.) Name of Institution Degree Field Completion Date</p><p>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</p><p>5. Working experience & Current occupation Name of Institution Position From － To</p><p>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? : </p><p>7. Applicant’s field of Earth Science (Please check one and write your specific field.) □ Geophysics【solid earth】(geodesy, seismology, volcanology, crustal geophysics, etc.)</p><p>□ Geophysics【fluid earth】(meteorology, oceanography, hydrology, geomagnetism, etc.)</p><p>□ Geology and Mineralogy (geology, mineralogy, geotectonics, paleontology, geomorphology, etc.)</p><p>Specific field: </p><p>8. Applicant’s statement of reasons for wanting to attend school 9. Subject of past research and Achievements</p><p>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.)</p><p>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.)</p><p>Name of person completing section 12: Position: Institution: Telephone: Fax: (Please include country and city codes for telephone & fax numbers.) E-mail address: </p><p>Send the completed application form by email to: [email protected]</p><p>Application Deadline: July 5, 2011</p><p>KAGI 21 International Summer School Secretariat Division of Earth and Planetary Sciences, Graduate School of Science Kyoto University, Kyoto, 606-8502, JAPAN</p>