Student

NIMS Internship Program Student Form

Last Name First Name
Name
*as appears on passport

Nationality Gender

Date of birth
Age
(yyyy/mm/dd)
Postal Code
Address for
correspondence

Contact Details Phone E-mail

Major

University

Expected
Year in university Admission
Graduation
Desired duration of internship
to
Up to 90 days

Details of Name Position

supervisory professor
of your university Affiliation
Should be Professor or
Associate professor Phone E-mail

□ IJSPS
am not currently receiving any scholarships or other financial assistance funded by the Japanese government, including the MEXT scholarship,
fellowships, and JST grants.

□ (Check the box if you are currently receiving any fellowships other than those listed above.)
I have already confirmed with the sponsoring organizations that receiving allowance from NIMS is not a problem.

Education
School names
Admission Graduation Degree and major
(from high school)

Describe your motivation for applying to this program.

Describe your current research at your university.

Note: JSPS researchers and MEXT scholars and JST fellowship are not eligible to receive the financial support from NIMS.