共同研究申込书-TohokuUniversity.DOC

(FORM 1) JOINT RESEARCH APPLICATION FORM (New / Ongoing) DATE: _________________, 20__ To: National University Corporation Tohoku University (Department Head) APPLICANT ADDRESS: COMPANY / INSTITUTION: REPRESENTATIVE: SIGNATURE: Company / Institution Name (“APPLICANT”) hereby submits the following Joint Research Application to Tohoku University (“TU”) in accordance with the University’s Joint Research Regulations. (*check one of the following) □ Application of Joint Research detailed in Attachment 1 – 3 involving a payment of Research Expenses (i.e. [Direct Expenses + Indirect Expenses + Resident Fee] or [Direct Expenses + Indirect Expenses]). (*NOTE 1) □ Application of Joint Research detailed in Attachment 1 only involving a payment of Resident Fee for APPLICANT’s Researcher(s) sent to TU to conduct the Joint Research at TU’s facility during the Research Period. (*NOTE 2) APPLICANT CONTACT INFORMATION Name Title Address Tel Fax E-Mail NATIONAL PROJECT (if applicable) Project Title Source of Funding (Governmental Body) OTHERS 　　Renewal / Continuation of Ongoing Joint Research Initial Effective Date: _________________________ RESEARCH CATEGORY (*check one) 　　 　　 　　 　　 / Materials 　　 　　 　　 　　Frontier 　　 *NOTE 1: Attachment 3 is not necessary if the project does not involve any payment from TU, or APPLICANT does not need to obtain the detailed breakdown of such payment from TU. *NOTE 2: Resident Researcher is defined as Researcher(s) sent to TU by APPLICANT for the purpose of conducting the Joint Research at TU’s facility during the Research Period. Prior consultations will be necessary for Applications only involving Resident Fee (but no other Research Expenses). Joint Research Agreement/Contract may not be required for the type of Joint Research only involving Resident Fee. Attachment 1 1. Research Title 2. Research Purpose 3. Research Description 4. Research Period FROM _________________________ TO ___________________________