Application Form for Joint ResearchMonth Day, Year

National University Corporation Kyushu University (“KYUSHU-U”)
Dean [Name][Department Name]

Applicant:[Address][Organization Name][Representative Name and Job title][Seal/ Signature](Attachment) Please submit this application form in WORD format file (data file) to Research Support Section of therelated department (faculty) simultaneously with sending a paper form at the time of application.
1.Research Theme1）
Please write down about the Research contents and roles as much information as possible.
[Contents of the Research.][KYUSHU-U’s role]
2.Description of theResearch[Applicant’s role]

From: Month Day, Year

3.Research Period

4.Research Team
(Affiliation/JobTitle/Name)※

A Principal
Researcher○Visiting Joint
Researcher
fromApplicant

Section

NameResearcher※

KYUSHU-U

Research
Collaborator(s)2）

To: Month Day, Year
Affiliation

Job Title

Researcher※
ApplicantResearchCollaborator(s)5.ResearchExpense

See below(IncludingConsumption Tax)

PaymentMethod3）□ One Time Payment of Full Amount□ Payment in Annual Installments□ Multiple Payments in one tax year
(If over the tax year, fill in every tax year. The tax year of Japan is from April to next March.)

From: Month Day, Year
Section

To: Month Day, Year
Research Expense(JPY)

Details
PLEASE DELETE THE DETAIL INFORMATION IF YOU
DO NOT ESTIMATE THE COST.

DirectExpenses

1.Expenses forappropriated for theResearcher4）

NAME:JPY(JPY/per hour xhours)

Time spent for especially for the Applicant<Total time spent for the Research (hours)>0NAME:JPY(JPY/per hour xhours)

Time spent for especially for the Applicant<Total time spent for the Research (hours)>

2.PersonnelExpense5）03.Travel Expenses

04.Equipment
Expenses
5.Consumption
Expenditure00

6.Others6）
7.Visiting JointResearcher’scost7）

0
30,000 JPY/ per month / per person（From : Month Day, Year0

To : Month Day, Year）

Total Direct Expenses

0Indirect Expenses8）

0

Subtotal of the Research Expense(Direct + Indirect Expenses)

0
From: Month Day, Year

Section

To: Month Day, Year
Research Expense(JPY)

Details
PLEASE DELETE THE DETAIL INFORMATION IF YOU
DO NOT ESTIMATE THE COST.
NAME:JPY(1.Expenses
appropriated for theResearcher4）

JPY/per hour xhours)

Time spent for especially for the Applicant<Total time spent for the Research (hours)>0

NAME:JPYDirectExpenses(JPY/per hour xhours)

Time spent for especially for the Applicant<Total time spent for the Research (hours)>

2.Personnel Expense5）03.Travel Expenses

04.Equipment
Expenses
5.Consumption
Expenditure006.Others6）

07.Visiting Joint
Researcher’s
Cost7）

30,000 JPY/ per month / per person（From : Month Day, Year0

To : Month Day, Year）

Total Direct Expenses

00

Indirect Expenses8）
Subtotal of the Research Expense (Direct + Indirect Expenses)

0

Total Research Expense

0

6. Location of the Research

KYUSHU-U:
Applicant:
Name[ Name of laboratory, etc. ]Type/Model No.

Amount

7.Received EquipmentAffiliation:
Job title:
Name:
Affiliation:
Job title:
Name:

KYUSHU-U
8.Principal Researcher’sContact Details

ApplicantTel:E-mail:Tel:
E-mail:Acceptance Requirement (The application may not be accepted without ticks.)
・“Expenses for appropriated for the Researcher” is included in the Direct Expenses.
□ Confirmed

9.Additional Information

・There is a plan to apply for reduction or exemption of the Indirect Expenses according to the KYUSHU-U
Regulations and Rules.
□Yes □No

Please tick the appropriate box.

□ Others: Please note if any.

1) Each year, KYUSHU-U publishes

1) A name of the Applicant(s) 2) the Research Theme, 3) the Principal Researcher’s name (including job title anddepartment) of KYUSHU-U regarding the Joint Research to show subsequence research activities.
□ Agree □ Not Agree (Reason:)2) If our student participates in the Joint Research as the Research Collaborator, such student will be required to sign a pledge to comply with obligations
stipulated in the Joint Research Agreement. Please make sure on such student’s name, affiliation and consent through the Principal Researcher ofKYUSHU-U before submitting this Application Form.
□ Confirmed with the Principal Researcher of KYUSHU-U.
3) Please check the box depending on your payment methods.
As a rule, we accept a lump sum payment in a total sum. If you wish an installment payment, please contact to KYUSHU-U administrator. Please also
confirm with your accountant regarding the dead line for the payment of a Research Expense.
4) “Expenses appropriated for the Researcher” means the expenses especially spent for the Applicant. Such expenses will be calculated according to thetime which especially for Applicant in total time spent for the Joint Research. Time spent specially for the Applicant will be determined according to thecontents of the Joint Research.

The point of “Time spent specially for the Applicant” is that, if the contents of the Joint Research is close to theResearcher’s professional academic field, it will be short, and vice versa.

“Expenses appropriated for the Researcher” will be used for promoting

ordinary academic activities in KYUSHU-U.
5) Research Administrator (URA), Research Fellow, DC Researcher, Technical Support Staff and Research Assistant6) Facilities costs, utilities, equipment rental fees, communication fees and transportation costs, etc.
7) 30,000 JPY/ per month (Excluding indirect expenses) per Visiting Joint Researcher should be added up.
8) Please add 30% of the Direct Expenses (round up the nearest 1,000 JPY) as the Indirect Expenses.
9）Please select the Research Field of this Joint Research.
Research Field ()① The life science field , ② The Information and communication field , ③ The environmental field , ④ The nanotechnology and Materials field ,⑤ The energy field , ⑥ The manufacturing technology field , ⑦ The social infrastructure field , ⑧ The frontier field , ⑨ Others

Administrative ContactKYUSHU-U(PrincipalResearcher)
Applicant(Contact Person)

Affiliation:
Job title:
Name:
Address
Affiliation:
Job title:
Name:

Tel:
E-mail:Tel:
E-mail: