Application Form

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Application Form 1
Application Form for Field Science Course and Genome Science Course 2015 fall
(英語より日本語が得意な方は、これではなく、日本語版の申請書に記入してください)
Candidates need to submit the following documents, by e-mail during the following period.
We would appreciate it, if you use a downloaded form.
This form can be downloaded at the following site,
http://www.wildlife-science.org/en/curriculum/index.html
Note that you are responsible for a cancellation charge of an air ticket, if you cancel Field
Science Course after booking.
Mail to: [email protected]
(Wildlife Research Center, Tel: 075-771-4388)
Deadline: 13, September 2015
1) Personal Record (as of October 2015)
Name 1)
last name
middle name
family name
Sex
Affiliation faculty
male
female
department
division
laboratory
Grade in University
Your supervisor
E-mail address 1 (that can
receive attached files)
E-mail address 2 (optional,
mobile phone address is
possible)
Do you have a university
students’ insurance
(Gakken-sai)? 2)
Birth date 3)
Age 3)
Phone number 4)
Yes
No
I do not know the insurance
Year
month
day
1)
Your name should be the same as that on your passport for booking your air ticket.
2)
university students’ insurance “Gakken-sai”
http://www.z.k.kyoto-u.ac.jp/f_guide_saigai.html
(Sorry, we do not find English pages on the insurance.)
3)
Birth date and age is necessary for reservation for transportation and insurance
4)
We may phone you to confirm your participation, because we need to reserve ticket ASAP.
Application Form 2
Summary of your own study at university
Application Form 3
5) Field Science Course
Do you apply to Field Science Course? Yes
No
If “Yes” fill in the following items.
Your first preference of the group
A) Deer B) Plant
Your second preference of the group
A) Deer B) Plant
Comment about the preference of the group (optional, e.g., My first preference is plant course, but
any course is OK as the next preference).
Summary of what you expect in Field Science Course
Your experience of field study
If you have attended the past Field Science Course in Yakushima, fill in the year and the course
title.
Application Form 4
If you need any consideration during your stay in Yakushima, please let us know.
1) Do you have any foods you avoid?
2) Do you need any consideration for your health?
3) Do you need any consideration for your religion?
Application Form 5
6) Genome Science Course
Do you apply to Field Science Course? Yes
No
If “Yes” fill in the following items.
Your first preference of the group
A) Deer B) Plant
Your second preference of the group A) Deer B) Plant
Comment about the preference of the course (optional)
Summary of what you expect in Genome Science Course
Your experience of genome study and experiments
If you have attended the past Genome Science Course, fill in the year and the course title.
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