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2021年度RJE3プログラム 基礎科目申請フォーム/FY2021 RJE3 Program Basic Subject Entry form
2021年度 RJE3プログラム基礎科目 FY2021 RJE3 Program Basic Subject
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* Indicates required question
1.Email Address
*
Your answer
2.Surname (Same as in Passport)
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Your answer
3.Given name (Same as in Passport)
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Your answer
4.Which term do you intend to apply?
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Short- term
Long-term
Required
5. Fieldwork Preference (Check you hope to take) ■Short-term: Please select A~G ■Long-term: Please select E~G
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A: ①Energy Security in Cold Climate Region ( 8/2-5)③ Fieldwork on development technologies in cold region（8/16-20)★RJE3 Introduction(8/23-27)
B: ②Rebun International Anthropological field school（8/1-/21) ★RJE3 Introduction(8/23-27)
C: ③Fieldwork on development technologies in cold region(8/16-20)★RJE3 Introduction(8/23-27)
D : ④Past and Present of Hokkaido(8/31-9/3) ★RJE3 Introduction(8/23-27)
E : ②Rebun International Anthropological field school（8/1-21) ④Past and Present of Hokkaido(8/31-9/3) ★RJE3 Introduction(8/23-27)
F: ③Fieldwork on development technologies in cold region(8/16-20) ④Past and Present of Hokkaido(8/31-9/3) ★RJE3 Introduction(8/23-27)
G: ①Energy security in cold climate region(8/2-5)③ Fieldwork on development technologies in cold region(8/16-20)④Past and Present of Hokkaido(8/31-9/3) ★RJE3 Introduction(8/23-27)
Required
6.Name of University
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FEFU
NEFU
ISU
SSU
PNU
Required
7.Home Institute
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Your answer
8. Course (Program)
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Bachelor
Master
Doctor
Post-doctor/Postgraduate
other
Required
9. School Year
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1
2
3
4
5
Required
10.Major
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Your answer
11. Research Thesis
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Your answer
12.Keywords of your Research
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Your answer
13.Expected graduation date
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Your answer
14.Sex
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Male
Female
Required
15. Date of Birth (YY/MM/DD)
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Your answer
16. Current Age
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Your answer
17. Postal Code
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Your answer
18.Current Address (Please write detail)
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Your answer
19. Phone Number
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Your answer
20.Passport Number
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Your answer
21.Passport expiration date ■A valid passport should have at least 2 pages of space in the visa section (pages for embarkation/departure stamps and visas), and 6 months or more from the date of arrival in Japan.
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MM
/
DD
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YYYY
22. Emergency contact person's full name and relationship. Example) Taro Hokudai (Father)
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Your answer
23.Emergency contact person's address
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Your answer
24. Emergency contact person's phone number
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Your answer
25.Emergency contact person's email address
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Your answer
26.Do you agree with using pictures on program website incl.SNS) and printed matters?
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Yes
No
Required
27. Have you ever participated in the RJE3 Program Summer School(RJE3 Basic subjects)? Yes or No. If Yes, write the year, month and date.
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Your answer
メールアドレス Email address
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Your answer
申請日 Date of Application
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MM
/
DD
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YYYY
学生番号 Student ID
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Your answer
課程 Course
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修士 Master
学士 Bachelor
博士 Doctor
学年 Year of Course
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1
2
3
4
漢字氏名 Name (Surname and First name)
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Your answer
フリガナ Furigana
*
Your answer
氏名＜パスポート標記と統一Surname, First nameの順＞
*
Your answer
希望実習コース（1の概論と2～9の基礎科目を1科目履修するとRJE3基礎科目修了証が授与されます）できるだけ概論と基礎科目の受講をお願いいたします。Course that you'd like to take(RJE3 Basic Course Completion Certificate will be awarded if you take 1 introduction and 1 basic course from 2 to 9.)複数選択可（Multipl selections available) Please take Introduction and Basic subject as much as possible.
*
1.RJE3概論：極東・北極圏の環境・文化・開発（2021.8/23-8/27予定）RJE3 Introduction(2021.8/23-8/27)
2.シベリア学演習：歴史・環境・寒冷地住環・地域経済（2021.11月予定）Seminar of Siberian Studies(2021.11)
3.寒冷地域のエネルギーセキュリティ（2021./8/2-8/5予定）Energy Security in Cold Climate Region(2021.8/2-8/5)
4.礼文国際考古学フィールドスクール（2021.8/1-8/21予定）Rebun International Anthropological Field School(2021.8/1-8/21)
5.寒冷地建設技術フィールドスクール（2021.8/16-8/20予定）Energy Security in Cold Climate Region(2021.8/16-8/20)
6.北海道の過去と現在ー石狩・空知の歴史ー（2021.8/31-9/3予定）Past and Present of Hokkaido: History of Ishikari and Sorachi(2021.8/31-9/3)
7.ロシアの歴史・芸術・文化（2021.9月以降予定）History, Art and Culture of Russia(2021.9)
8.ヤクーツク実習：北極域永久凍土生態系実習（2021.12～2122.3月中に予定）Yakutsk Field Short Course(2021.12～2022.3)
9.日露デザインスクール（2021.7/5-7/16・2022年2月のいずれかの参加予定）Design School of Japan and Russia(2021.7/5-7/16・2022.2)
Required
所属学部（大学院）・専攻・専門《英語標記》(Graduate) School/Division/Major
*
Your answer
郵便番号 Postal code
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Your answer
現住所 Current Address
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Your answer
電話番号（携帯可）Phone number
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Your answer
性別 Gender
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男 Male
女 Female
生年月日 Date of Birth (YY/MM/DD)
*
MM
/
DD
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YYYY
パスポート番号（派遣プログラムに参加希望で、取得済みの場合記載）Passport Number
Your answer
パスポート有効期限（パスポートは申請するビザの出国期限より6か月以上有効期限があること/査証欄に1見開き+１ページ（計３ページ）以上の余白があること Passport expiration date (passport must be valid for 6 months or more from the departure expiration date of the visa you are applying for / 1 spread + 1 page (3 pages in total) or more in the visa column
MM
/
DD
/
YYYY
指導教員名 Supervisor name
*
Your answer
指導教員の職名 Supervisor's title
*
Your answer
指導教員から本プログラムの参加について同意を得ていますか。 Do you have a permission from your Supervisor to participate in this program?
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はい Yes
いいえ No
研究テーマ（日本語）
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Your answer
研究テーマ（英語）Theme of your research
*
Your answer
研究キーワード（日本語）
*
Your answer
研究キーワード（英語）Keyword of your research
*
Your answer
英語（TOEIC/TOEFL等）のスコア（テスト名・スコア）English Proficiency Score(Name of exam and Score)
Your answer
上記取得年月日 Date of acquisition above
MM
/
DD
/
YYYY
1.現在日本学生支援機構の奨学金を受給していますか？. Are you currently receiving a Japan Student Services Organization scholarship?
はい Yes
いいえ No
Clear selection
種類 Type of the Scholarship
Your answer
奨学生番号 Scholarship Student Number
Your answer
渡航支援金について（JASSO奨学金対象者で家計基準を満たしている方のみ回答ください）≪JASSO奨学金支給条件≫※北海道大学の大学院生であること。（学部4年生は北海道大学の大学院に進学予定であること）※在籍課程の前年度（前年度の成績がない場合は前学期）の成績評価係数（GPA）が、上記計算式で2.30／3.00以上であること。（RJE3プログラム参加要件2.00／3.00より数値が高いので注意）※日本国籍を有している者。または日本への永住が許可されている者。※経済的理由により自費のみでの採択プログラムが困難な者。※規定の報告書と必要書類を提出できる者。※今後RJE3プログラム主催の交流会・報告会などに参加する者。About travel support (Please answer only if you are eligible for the JASSO scholarship and meet the household standards) << JASSO scholarship payment conditions >> * Being a graduate student at Hokkaido University. (4th year undergraduate students are scheduled to go on to graduate school at Hokkaido University) * The grade evaluation coefficient (GPA) for the previous year of the enrollment course (or the previous semester if there is no grade in the previous year) is 2.30 / 3.00 using the above formula. That is all. (Note that the value is higher than the RJE3 program participation requirement 2.00 / 3.00) * Persons with Japanese nationality. Or those who are permitted to live permanently in Japan. * Those who have difficulty in adopting a program at their own expense due to financial reasons. * Persons who can submit the prescribed report and required documents. * Those who will participate in exchange meetings and debriefing sessions hosted by the RJE3 program in the future.
希望する Yes,I'd like to.
希望しない No, I would not.
Clear selection
次のうち一つを選択してくださいPlease choose one
独立生計者である Self-supporting subsistence
父母の扶養である Dependent of Parents
Clear selection
緊急連絡先氏名（漢字とフリカナ）Emergency Contact person
*
Your answer
緊急連絡先の方とあなたとの関係 Relationship with the person
*
Your answer
緊急連絡先住所（郵便番号から入力してください）Emergency contact address
*
Your answer
緊急連絡先電話番号Emergency contact phone number
*
Your answer
緊急連絡先メールアドレス Emergency contact email address
*
Your answer
2.プログラム実施中に撮影された写真にあなたが写っていた場合、Webや印刷媒体（チラシ・報告書等）で利用してもよろしいですか？2. If you are in the photo taken during the program, can we use it on the web or in print media (flyers, reports, etc.)?
*
はい Yes
いいえ No
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