【2024 International Collaborative Research】

Example2024 APPLICATION FORM

For International Collaborative Research with IPR, Osaka University(1) APPLICANT
Family Name○○○○○

Given Name(s)○○○○○Nationality●●●●

Country of Residence■■■■

DegreePhD

Date of BirthDay

Affiliation

Department of Chemistry, △△△ University

Job Title

Professor

Postal Address

3-2 Yamadaoka, Suita-city, Osaka 565-0871, JAPANE-mailtanpakuken-kyoten@office.osaka-u.ac.jp

Phone+81-6-6879-4323

Fax+81-6-6879-8590

3MonthAprilYear

1972

Male/FemaleMale(2) Period
Proposed Date of Arrival at IPRDay

15MonthSeptember

Year

2024

Proposed Date of Departure from IPR

Day5Month

October

Year

2024

21daysDuration(3) The estimated costs for the travel expenses (coach class airfare) and accommodation fees.
Please note that the amount of support will be determined based on the available fund.
AirfareAccommodation fees
Total

300,000JPY (150,000JPY × 2 persons)60,000JPY ( 10,000JPY × 2 persons × 3 nights)
360,000JPY* e. g. Airfare 150,000JPY × 2 persons, Accommodation fees 10,000JPY × 2 persons × 3 nights,etc.

(4) Research Collaborator at IPR, Osaka University
Host PI○○○ ○○○

Professor
Collaborator (title)○○○ ○○○ (Assistant Professor)

Recommendation*This section must be filled by the host PI of IPR.

DateDayMonthYear

1

Total 360,000JPY【2024 International Collaborative Research】(5) Accompanying Researchers*When researchers other than the applicant will also come to IPR, provide their information below.

Accompanying researcher 1
Family Name□□□□□

Given Name(s)□□□□□Nationality●●●●

Country of Residence■■■■

DegreeBachelor’s degree

Date of BirthDay

Affiliation

Department of Engineering, ◇◇◇University

Job TitleGraduate Student

Postal Address

3-2 Yamadaoka, Suita-city, Osaka 565-0871, JAPANE-mailtanpakuken-kyoten@office.osaka-u.ac.jp

Phone+81-6-6879-4323

Fax+81-6-6879-8590

10MonthSeptemberYear

1992

Male/Female

FemaleAccompanying researcher 2
Family Name□□□□□

Given Name(s)□□□□□Nationality●●●●

Country of Residence■■■■

DegreeBachelor’s degree

Date of BirthDay

Affiliation

Department of Engineering, ◇◇◇University

Job Title

Graduate Student

Postal Address

3-2 Yamadaoka, Suita-city, Osaka 565-0871, JAPANE-mailtanpakuken-kyoten@office.osaka-u.ac.jp

Phone+81-6-6879-4323

Fax+81-6-6879-8590

10MonthSeptemberYear1992

Male/FemaleFemale

Accompanying researcher 3Family Name□□□□□

Given Name(s)□□□□□Nationality●●●●

Country of Residence■■■■

DegreeBachelor’s degree

Date of BirthDay

Affiliation

Department of Engineering, ◇◇◇University

Job Title

Graduate Student

Postal Address

3-2 Yamadaoka, Suita-city, Osaka 565-0871, JAPANE-mailtanpakuken-kyoten@office.osaka-u.ac.jp

Phone+81-6-6879-4323

Fax+81-6-6879-8590

10MonthSeptemberYear1992

Male/Female*Delete/add columns depending on the number of accompanying researchers.
2Female【2024 International Collaborative Research】(6) Research Title○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○(7) Continuation*() If this is a continuation of a previously awarded research proposal, please indicate by checking thebrackets below and providing detailed progress.

The title of your previous research plan(s):○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○The period of your previous research:(8) Research Plan (no more than 2 pages)Background:
Amyloid fibril formation is considered as a critical event that leads to the pathogenesis of Alzheimer’s
disease in brains and ....
Specific aims:
1. To elucidate molecular mechanism of ... by applying ....
2. To identify amino acid residues implicated in ... by using solution NMR.
3. To determine 3D structure of .... by X-ray crystallography.
Methods:△△△△△△△△△△△△

Role(s) of the host researcher at IPR:●●●●●●●●●●●●

Expected scientific outcome:□□□□□□□□3

【2024 International Collaborative Research】

Research plan (continued)(9) Curriculum Vitae of Applicant (Starting from the last education to the present affiliation)
Education:
B.S in Chemistry ○○University
PhD. Chemistry △△University

1990, March
1996, March

Employment History:
Professor, ○○University
2003, October - Present
Associate Professor, ○○University 1996, April – 2003,September
Publications:…………………………
…………………………
Grant:…………………………
…………………………
Awards:…………………………
…………………………

(10) Curriculum Vitae of Other Researchers (Starting from the last education to the present affiliation)
Accompanying researcher 1
Education:
B.S in Chemistry ○○University

1990, March

Publications:…………………………
…………………………
Grant:…………………………
…………………………
Awards:…………………………
…………………………
* Delete/add columns depending on the number of accompanying researchers.
4【2024 International Collaborative Research】(11) List of publications relevant to the proposed research*Please include “title”, “authors”, “Journal name”, “volume”, “page numbers” and “the year of publication”.

* Expand the column height when necessary.

(12) Signatures
Applicant*Please fill in your signature here.

Signature
DateDayMonthYear

Director of your affiliated institution
I permit the applicant and other researcher(s) to apply for the collaborative research.
*Please have it signed by the director of your affiliated institution.
Signature:
NameTitle
DateDayMonthYear*If you have any questions, please feel free to contact us at:
Project Team of Joint Usage / Research Center, IPR, Osaka University
E-mail: tanpakuken-kyoten@office.osaka-u.ac.jp

5