＜Example for Applicant from Overseas＞

K ochi Core Center O pen F acility S ystem (KOFS)
Application Form for Use
Date of application

10/01/2017

Please complete both pages of the form and submit to KOFS Administration Office by email.
Email: kcc-kyoyo@kochi-u.ac.jp Visit: http://www.kochi-core.jp/kyoyo/index.html

Applicant/Representative
Name
Affiliationand Position
Address
Phone Number
EmailAbc Xyz
Department of ABC, XXX research center, University of XYZResearch Associate
123 xxx Avenue, yyyyy, zzzzzz, 12345 U.S.A.
Fax Number+1-00-0000-0000
xxxxxxx@*********<For a student only>
Name of the supervisor:
Affiliation if different:
Email:

Zip Code :12345+1-00-0000-0000<For a fixed-term researcher only>
Name of Grant or Fellowship:

Team Members* If the group has

Nameover 3 people, add

1 Abc Xyz
23
Name: Abc Xyz

any rows asneeded.

Emergency
Contact

Affiliation and Position
University of XYZ/Research Associate

Emailxxxxxxx@*********
In case of an emergency, write down
contact information during your visit.

Cell Phone Number or Email: 080-0000-0000 only in JapanInformation about Your Application
Proposal Title

Analysis of XXX distribution in seawater and marine sediments

Research
Purposes andAnalyticalPlans;*Please describe your analytical plans in detail including needs of instrumental facilities in KOFS.

Equipment
you want to use

In recent years it has been shown that microorganisms belonging to XXX family have an
important role in …. However, the distribution of these microorganisms in the marine
environment is poorly understood. In this study, the presence of XXX in several seawater andsediment samples will be analyzed using the DNA sequencer.

Name of Equipment
DNA sequencer

Type of Use■ Use of Equipment□ Technical Consultation

Prior Discussion withthe person in charge□ DoneName:■ Not yet
□ DoneIt is necessary to submit an application
form every academic year, which begins
in April and ends in March.

□ Use of Equipment
Pleasecontact us in advancewhen youName:□ Technical Consultation□ it
Notyet to
couldn’t speculate how longtakes□ Doneanalyze： kcc-kyoyo@kochi-u.ac.jp□ Useof Equipment□ Technical Consultation

Desired PeriodPriority 1st2nd
3rd

10/25/2017 - 10/26/2017
11/05/2017 - 11/06/2017
mm/dd/yy - mm/dd/yy

Name:□ Not yetTotal
TotalTotal

1 days1 daysdays

SamplesProprietor

96
1Abc Xyz

Proprietary Rights/License□

Number of Samples
Number of Measurement Per Sample□ Others□□ Animal Cell

Human Cell
■ Microorganism

Origin of Samples
Specify BSL when Sample is Biological.

□ Not applicable

Allowed■ Applicant□ Others

BSL level ofKochi CoreCenteris P2.
*Attach an optional sheet about the informationof samples
if necessary
Biosafety level (BSL): 1

List of Samples

DNA sample (dissolved in water/buffer)
Important Notice for Handling andStorage

Procedure ofSafety

Applicable
Legislation (1)Need to be stored at -20°C

■
□□
□
□

Does not apply
International Controlled Material
Hermetically Sealed Radioactive Substance
Poisonous and Deleterious Substances Control ActOthers■

Does not apply□ Accepted / Authorized□ Under process

About handling of the information
Regarding the use ofKOFS(2)■ I agree to open the information about this use to the public.
□ I don’t agree to open the information about this use to the public.

Requests*Supplementary Survey
We would appreciate it if you could tell us how you knew about KOFS.
■ Web Site

□ Academic Society :Name□ Colleagues :Name:□ Others(1) Applicable Legislation: Examples are listed below.
 Animals and Plants, and Processed Food regulated by Washington Convention
 Samples collected from sites of World Heritage, Quasi-national Park, Special Sanctuary and NaturalMonument
 The use of genetic resources specified by Convention on Biological Diversity and the guidelines ofNagoya Protocol Samples such as soil samples under Article 7 of Plant Protection Act(2) Please contact us if you need more information：kcc-kyoyo@kochi-u.ac.jp
Notice of Application
 Payment of use charge is the responsibility of the representative.
 Additional documents may be necessary to submit, depending on samples and specific instrument.