Nakasone Award Application

Application for Nakasone Yasuhiro Award
中曽根康弘賞にご関心をお寄せいただきありがとうございます。 応募の受付期間は 12 月 1日から翌年 3 月 31 日までとなっています。この申込書に必要事項を記入の上、末尾の受付事務局に電子メール、ファックス、または郵送で応募してください。

Thank you for your interest in the Nakasone Yasuhiro Award. Applications are accepted
annually from December 1 to March 31 for award announcement the following July. Please
fill out this application as completely as possible and return it by email, fax, or post to any of
the contact points at the end of this form.

Applicant Information
Family Name:
Birth date:Today’s date:
First Name://Middle initial:

Nationality:(month / date / year)

Postal address:

Telephone number (incl. country code):
Email:

Website (optional):

職歴 Professional experience (current affiliation first)
現在の所属機関 Current professional affiliation (address, phone number, website)
Dates of affiliation

Title

Organization

Contact information

過去の所属機関 Previous affiliations, organizations (dates, address, phone number, website, title)
Dates of affiliation

Title

Organization

Contact information

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Nakasone Award Application

学歴（最終学歴、学位を最初に記載してください）
Education (most recent educational institution or degree first)
Dates

DegreeMajorInstitution

業績 賞の対象となる業績（４００字以内）
Achievement Please describe the achievement that meets the eligibility of the Award. (maximum200 words)

賞のテーマ（該当するものに〇をつけてください）Award themes (please circle relevant theme)

1. 国際社会における平和と安全の確保
Enhancing peace and security in the international community
2. 国際経済の発展及び経済協力等の推進
Promotion of international economic development and cooperation
3. 文化・芸術交流、文化協力等国際的文化活動
Activities to support international exchange in culture and arts as well as cultural cooperation
4. 国際科学共同研究、科学技術協力等科学技術分野における国際的活動
International joint research and international collaboration in fields of science and technology.
5. 環境、エネルギー、医療、貧困等地球規模の諸問題に対する取組み
Efforts in such global issues as the environment, energy, medicine, poverty, etc.

受賞歴または表彰歴（最新の賞より順に記載してください）Awards or recognitions (most recent awards first; please indicate those that relate to the subject
achievement)

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Nakasone Award Application

出版物 （主な出版物・掲載誌を最新のものより順に記載してください）
Publications (most recent publications first; please indicate those that relate to the subject
achievement)
Date published
Title
Publisher
Journal (if applicable)

推薦 本分野の専門家からの推薦状を２通提出してください。その推薦者の氏名所属を記載してください。
Recommendations Please submit two letters of recommendation from experts in the subject field.
Fill in their names and affiliations below.

NameAffiliation

NameAffiliation

Thank you for your application. Please note details below.

詳細 Award specifics
授賞式、資格、応募手続等の詳細については、NPI ウェブサイトの中曽根康弘賞をご参照ください。追加情報が必要な場合は 応募者に直接ご連絡いたします。
応募委頂きました情報は、中曽根賞の選考にのみ使用させていただきます。提出いただきました書類は返却いたしません。
For additional details regarding the Award, please refer to the notice “Accepting Applications
for the Nakasone Yasuhiro Award” on the NPI website: www.iips.org
In some cases, if additional information is required, applicants will be contacted individually.
The information on this application and other documents will be used solely for considerationin the Nakasone Award selection process. The documents will not be returned to the applicant.

注記 Notes:
電話でのお問い合わせは受付けていません。
審査結果は NPI ウェブサイト：www.iips.org に 7 月末までに発表いたします。個別の連絡は行いません。
Please be advised that telephone inquiries will not be accepted.
Announcement of the results will be made on the NPI website: <www.iips.org> by the end of
July and no individual contacts will be made.
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応募に関する問い合わせは下記事務局にお願いします。
Applications and inquiries may be directed to:事務局
中曽根平和研究所〒105-0001
東京都港区虎ノ門 3-2-2
Fax：03-5404-6650

30 森ﾋﾞﾙ 6 階+81-3-5404-6650（海外より）
E-mail：nakasone.award@iips.org
Administrative Office
Nakasone Peace Institute (NPI)
30 Mori Bldg., 6F
3-2-2 Toranomon, Minato-ku, Tokyo 105-0001 Japan
Fax: 03-5404-6650 (within Japan)+81-3-5404-6650 (from overseas)
E-mail: nakasone.award@iips.org

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