Application Form for Working Memory Prediction Data Usage
I, the undersigned, understand that the DecNef-Project Consortium requires that the following Data Use Terms
be signed, submitted and approved before applicants may receive access to the Database generated by theDecoded Neurofeedback Project within Strategic Research Program for Brain Sciences (SRPBS), BMI
Technology Application of DecNef for development of diagnostic and care system for mental disorders andconstruction of clinical application bases supported by supported the Japanese Advanced Research andDevelopment Programs for Medical Innovation (AMED). I hereby give consent to the following terms of use of
the Database (hereinafter referred to as “WMP Data”).

A. Definitions of WMP Data Elements covered by these terms:
1. Matrix data of functional connectivity conducted by resting-state fMRI
2. Subject information (e.g. gender, age, working memory score, cognitive test score)

B. Qualification to Obtain Access:I, as an applicant, am expected to meet one of the following criteria to qualify as a party granted access to WMP
Data:
1. I am a Principal Investigator (PI) of scientific research at a university, a research organization (includingcommercial entities) or a government agency who is the leader of a laboratory or research team or who isworking independently; or
2. I can provide the name of the PI who is overseeing my research and is approved for access under #1.
3. If I do not meet either of the above criteria, I may still be considered qualified based on a track record ofscientific publications or on the basis of a written reference from someone who meets qualification #1,
verifying that the data will be used only for the purpose of legitimate scientific research.

C. Responsibility for WMP Data
1. ATR is responsible for the data uploaded to the WMP Database. If ATR finds any bug or mistake, ATR
will appropriately update the database and release information describing such changes on the WMP
Database website (https://bicr.atr.jp/dcn/en/database-wmp/).
2. ATR accepts no responsibility for any direct or indirect damage or any loss attributed to the use of WMP
Data.

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D. Obligations of Applicant
I request access to WMP Data collected by the ATR DecNef Project. To ensure proper use of WMP Data and toprotect the privacy of WMP subjects, I agree to abide by the following terms.
1.
Initial☐ I am a Principle Investigator (PI) as defined above in B.1.
OR☐ I am not a PI.
Please complete and submit this application. ATR must additionallyreceive an application from the applicant’s PI before ATR can process
this application.
☐ Name of PI (please print legibly)
2.

I will not redistribute the WMP Data.

3.

I will keep WMP Data secure (password protected so that the data are

Initial

Initialaccessible only to individuals who have already been granted access).
4.

InitialTo meet restrictions on publishing WMP Data elements of individualsubjects, I will assign and only use my own study-specific subject ID foreach individual, e.g. subjects A, B, C, etc.

5.
InitialI will use the WMP Data exclusively for the purposes of scientific research,technology development, and education under the auspices of an academic,research, government or commercial entity.

6.
Initialpresentations, or other publicly available documents.
7.

InitialI will not assume or assert that ATR has any responsibility for any direct
or indirect damage or loss attributed to use of WMP Data.

8.
InitialI will contact ATR by email when I publish manuscripts, conference

I will cite WMP Data using the expressions given on the WMP Databasewebsite (https://bicr.atr.jp/dcn/en/database-wmp/).

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Applicant information (required for all applicants):

Name:
Position or title:(e.g. Professor, Postdoc, Graduate Student)
Institutional affiliation:
Highest academic degree:
Email address:
Daytime telephone number:

Applicant SignatureDateè NOTE: Either electronic or handwritten initials and signatures will be accepted.
Submitting this application
The applicant should save this completed, signed and initialed form, naming it with applicantʼs family name andfirst initial (e.g. Yamada_T.pdf), and send it as a scanned PDF file or JPEG/PNG/TIFF image to dcn_db@atr.jp.
è Please note that it may take up to a week before this application is considered for processing.
Questions about this document and its provisions should be sent to dcn_db@atr.jp.

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