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.