Enter into the electronic application system to create this form.
(Researcher Form 1)

Leading Initiative for Excellent Young Researchers FY2023 Application Form
Receipt Number
Research field
Field

Basic Section code

Medium-sized Section
Basic Section
Specialized research field

Keywords

Name (for display)
GenderNationality
Date of birth
Contact(E-mail)researchmap
Name of institution
Institution type
Current affiliation

Location

Postal code:

Name of department/section
Position
Academic status
Graduate school
Academicbackground forPhD

Faculty
Major
Completed/ withdrawn
YYYY/MMDegree awarded dateDegree nameEnrolled in the medical field which requires
clinical training
Research/jobhistory
Research interruption due tochildbirth/child care
Research interruption period due tochildbirth/child care

Employment status

Institution type interested innegotiation among theparties (Up to three)□ University□ Inter-University Research Institute Corporation□ College of technology□ National Research and Development Agency□ Public Research and Development Institute□ Company etc.

Other information to register
The items entered hereinafter are not used for screening nor displayed in documents that provide information
to the institutions.

Institution type of first choiceName(name on the family register)

Postal code:
Current address

Tel:

Cell phone:*It is possible to change the current address (contact E-mail) after submitting the application form, however, it
will not be reflected in the PDF file created at the time of submission of the application form.

Agreement upon application
Please read the following notes before applying.
1)

Please check if you do not agree to provide your information to the research institutions which
offered the publicized posts at the time your application has been accepted. In addition, if you
are selected as an Excellent Young Researcher Candidate, your name etc. will be listed on the“EYR Candidates list” and your information will be provided to the institutions. The
information provided to the institutions is Form 1 and Form 1 Attachment.
□ I do not agree to provide my information to the institutions at the time my application has
been accepted.

2)

Please check the box if you do not agree to provide your information to the agencies supportingnegotiation among the parties at the time the agencies will be decided, after your application
has been accepted. In addition, if you are selected as an Excellent Young Researcher Candidate,your name etc. will be listed on the “EYR Candidates list” and your information will beprovided to the agencies. The information provided to the agencies supporting negotiation
among the parties is Researcher Form 1, Form 1 Attachment, and “Institution type of fir stchoice.” Please confirm and agree to the conditions before filing the application.
□ I do not agree to provide my information to the support agencies at the time the agencies will
be decided after my application has been accepted.
□ I agree to provide my information to the support agencies if I am selected as an Excellent
Young Researcher candidate.

3)

Before filing the application, please make sure you read the “Application Guidelines for FY
2023 Leading Initiatives for Excellent Young Researchers.” If major errors, omissions and thelike are identified after the application is filed, the determination as an Excellent Young
Researcher Candidate or as an Excellent Young Researcher may be revoked. Please confirm andagree to the conditions before filing the application.
□ I read the “Application Guidelines for FY 2023 Leading Initiatives for Excellent Young
Researchers” and understood the contents.
*As for handling of personal information, please refer to the Application Guidelines “V.
Points to be considered (16) Handling of personal information”.
□ I confirmed that there are no errors in the application above or attached separately.