Appendix Form 1 (Matters relating to the Section 9)[insert MONTH] [insert DATE], [insert YEAR]

Application Form for Collaborative Research Project
Attn.: President,

TOYOHASHI UNIVERSITY OF TECHNOLOGY,
National University Corporation

Address

ZIP Code:441-8580
1-1,
Hibarigaoka,
Tempaku-cho,
Toyohashi City, Aichi Prefecture, Japan

NameofTUT Inc.
Organization
Name and Title
Presidentof Principal

Seal

Signature

I hereby apply for the Collaborative Research Project with TOYOHASHI
Signatureseal withCorporation,
signatory authority
is below in
UNIVERSITY OF TECHNOLOGY,National orUniversity
as describedrequired.
full compliance with the Agreement on Collaborative Research Project with private sector
institutions or the like stipulated by TOYOHASHI UNIVERSITY OF TECHNOLOGY.
NOTE

1. Theme of Collaborative Research
Research on [ insert THEME of COLLABORATIVE RESEARCH]

2. Goal(s) and Description of Collaborative Research
Describe an outline of goals and contentof proposed collaborative research.
3. Research Period
From the Effective Date of the Agreement on Collaborative Research Project to[insert MONTH] [insert DATE], [insert YEAR]
Multi-year
available.

agreementis4. Research Location(1) The University
TOYOHASHI UNIVERSITY OF TECHNOLOGY,
Faculty of [insert FACULTY ](2) The private sector institution or the like (in the case of sharing type research)

TUT Inc., Tempaku factory
Collaborative researcher who is to engage in thecollaborativeresearchattheUniversity
5. Burden of Research Fundingas ”Collaborative Researcher from private sector or
Research Funding for Collaborative Research
Facilitiestoofcontributethe University
the like”atistherequired
the research fee
below (per person):
Short term (within six (6) months): JPY 210,000
Share in Expenses
borneby (longerPrivate Sector
Institutionor theLong
termthan six(6) months
upliketo one (1)(includingconsumptiontaxandlocal
consumptiontax)year): JPY 420,000
Fiscal Year
Direct Expense
Indirect Expense
Research FeeTotal
2012

JPY 1,818,182

JPY 181,818

JPY 0

JPY 1,000,000

NOTE: In case the collaborative research period is multi-year, describe for each fiscalyear.
10% of direct expense is to becontributed as indirect expense for anappropriation
forenvironmental
improvement of the entire University
and expenses for the maintenance ofIPRs.

6. Researchers to Participate Collaborative Research

Name

Current Field ofRole under
Organization andExpertise
CollaborativeTitleResearch Project
Only collaborative researcher from private sector
or the like engaging in the collaborative research
project at the University shall be identified with“*”.

PartyThe Private
SectorInstitution orthe like*#The University

Note: Name of the collaborative researcher from private sector or the like (i.e., thecollaborative researcher who is to engage in the collaborative research project at theUniversity as the collaborative researcher from private sector or the like) shall be identified
with “*”, and name of the principal researcher shall be identified with “#”,

7. Facilities/Equipment(1) Equipment Furnishable to the UniversityDescribe “N/A” if not applicable.
NameEquipmentofType/Specification
Quantity
Installation
Required?
Remarks

(2) Facilities/ Equipment at Private Sector Institution or the likeEquipment
Name of Facility
Name of Equipment

Specification

Quantity

8. Administrative Contact Information
Describe the name of the person
in charge of contract andadministrative proceedings suchas document transmittal.

Name of Contact
Personnel
Name of Section
Address

ZIP Code:Tel.
Facsimile
E-mail9. Miscellaneous

No attachment is required if no“collaborative researcher fromprivate sector or the like” is toengage in the collaborative
research at the University.

ATTCHMENT:
Biography of the collaborative researcher from private sector or the like(In case the collaborative researcher from private sector or the like is to engage in thecollaborative research)

Biography of Collaborative Researcher from Private Sector or the like

Name of Researcher

Date of Birth[insert MONTH] [insert DATE], [insert YEAR]ZIP Code:
Present Address

Month/ Year
Educational
Attainment

Organization

Present Title

Name ofPosition

ResearchSubject

Remarks

Male/Female

GenderItems(Age:)