＜様式＞「グローバル実践科目」の単位認定申請書
Application Form for Credit Recognition of Practical Courses in Global Activities
Year２０２２年
環境生命科学研究科長

MonthDay○月○日

殿Course

環境生命科学研究科 Doctor’s 課程
Division

Agricultural and Life Science 専攻
Student No

学生番号N氏ame

名Supervisor

指導教員

７７５０１ＸＸＸ○○○■■

Signature

○○

（自 署）

■■

印又は自署

下記科目の単位認定を希望しますので，関係書類を添えて申請します。
I apply for the credits recognition with reference documents for following activities.
授業科目名

単位数Credits

Subjects

Presentation at International Conference A

グローバル・プレゼンテーションＡ

いずれかに○印 Circle○Activity to Recognize

Presentation at anmeeting held overseasinternational

academic

国外開催の国際学会における発表

Presentation at International Conference B

グローバル・プレゼンテーションＢInternational

１

対象Internship（short term）

インターナショナル・インターンシップ（短期）International Internship（long term）
インターナショナル・インターンシップ（長期）Name of host organization

１

Presentation at an international
meeting held in Japan

国内開催の国際学会における発表

１

Practical activities overseas
国外における実践的活動

２

Practical activities overseas
国外における実践的活動

Activity schedule

受入機関等名称活 動 日 程Name of meeting

academic

Schedule

会議等名称
The ○th International Conference

開催日程
May 2, 2022of ○○to May 5,2022

Name of person in charge

受 入 れ 担 当 者

Presented by O r a l ／ P o s t e r s

発表形式(口頭／ﾎﾟｽﾀｰ)

Oral

P l a c e

活動場所

P l a c e

活動場所
Vancouver,
Canada (online)

内訳 Details
内容 Content

具体的に記載 Please describe specifically

時間 Time spent

Learning withguidance of thesupervisor

Guidance in preparing PPT for presentation

12 hourspresentation practice in the laboratory

2 hours

Post presentation debriefing (in the lab)

1 hourPreparation ofTime required to create PPT

23 hours

Oral presentation at the conference (May 4, 2022, 13:15-

0.25 hourpresentation materials
Actual presentation

13:30)
Reporting※１

Preparing a report to the faculty advisor after the conference

8 hours合計時間
Total46.25hours

Documents which prove the practical activities (a pledge, documents issued by the host institute or person

in charge, etc.), and/or document which proves the presentation or attendance at the meeting ( summary of themeeting, nameplate, etc.) are required. “Studies instructed by the supervisor” must be included in “Details” at thetable above. Also, a copy of your report to the supervisor or a document such as overview, results and discussion on
the presentation or activities) is necessary.
※２

Description of more than 45 hours for 1 credit and more than 90 hours for 2 credits are necessary.

＜様式＞「グローバル実践科目」の単位認定申請書
Application Form for Credit Recognition of Practical Courses in Global Activities
Year

２０２２年
環境生命科学研究科長

Month○月Day○日

殿Course

環境生命科学研究科 Doctor’s 課程
Division

Agricultural and Life Science 専攻
Student No

学生番号N氏ame

名Supervisor

指導教員

７７５０１ＸＸＸ○○○■■

Signature

○○

（自 署）

■■

印又は自署

下記科目の単位認定を希望しますので，関係書類を添えて申請します。
I apply for the credits recognition with reference documents for following activities.
授業科目名

単位数CreditsSubjects

Presentation at International Conference A１

グローバル・プレゼンテーションＡ

いずれかに○印 Circle

Activity to Recognize

Presentation at an
meeting held overseasinternational

academic

国外開催の国際学会における発表

Presentation at International Conference B

１

グローバル・プレゼンテーションＢ
International

対象Internship（short term）

インターナショナル・インターンシップ（短期）International Internship（long term）
インターナショナル・インターンシップ（長期）Name of host organization

Presentation at an international
meeting held in Japan

国内開催の国際学会における発表

１

Practical activities overseas
国外における実践的活動

２

Practical activities overseas
国外における実践的活動

Activity schedule

受入機関等名称活 動 日 程Product Development Dept.

Aug 21, 2020 toMitsubishi Corp.

Aug 26, 2020

Name of meeting

Schedule

会議等名称

academic

開催日程

Name of person in charge

受 入 れ 担 当 者Manager, Planning Section,
Product Development Dept.
〇〇 〇〇Presented by O r a l ／ P o s t e r s

発表形式(口頭／ﾎﾟｽﾀｰ)○P l a c e

活動場所
Vancouver,CanadaP l a c e

活動場所

内訳 Details
内容 Content

Learning withguidance of thesupervisor
Activities at the hostinstitution

Reporting

具体的に記載 Please describe specifically
Preliminary research on the host institution, pre-visit, andguidance on preparedness
Post-activity debriefing (in the lab)

時間 Time spent

Orientation, safety instruction by instructor, tour of the plantTour, Critique
Practical guidance by supervisors, exchange of opinions, andcritiques
Practical guidance by supervisors, exchange of opinions, andgeneral comments

3 hours×1 day

Preparing a report to the supervisor after the activity iscompleted

6 hours

6 hours
1 hour7 hours×4 days
3 hours×1 day

合計時間
Total 47 hours※１Documents which prove the practical activities (a pledge, documents issued by the host institute or person

in charge, etc.), and/or document which proves the presentation or attendance at the meeting ( summary of themeeting, nameplate, etc.) are required. “Studies instructed by the supervisor” must be included in “Details” at thetable above. Also, a copy of your report to the supervisor or a document such as overview, results and discussion on
the presentation or activities) is necessary.
※２

Description of more than 45 hours for 1 credit and more than 90 hours for 2 credits are necessary.