Notification of Overseas Travel Please be sure to submit the following overseas travel notification after obtaining permission from your academic advisor or group teacher 3 weeks before traveling overseas (including private travel). About prior confirmation (* Please check "No" for private travel.) Please answer the following questions because we are supposed to confirm the security export control in advance. (1)I will provide technology to others in overseas business trips. Please check either one. (Please answer “No” if you will take the technical information to overseas only for your own use not to provide or disclose the technology / information to others. Also, please answer “No” if you provide the technical information at the international academic conference that anyone can participate in without any entry qualifications.*Required YESNO (2) I will carry or send separately the research equipment to overseas such as measuring instruments and samples other than commercially available personal computers, digital cameras or mobile phones in overseas business trip. Please check either one.*Required YESNO Your Information Name*Required Ex.) Tarou Yakugaku Student ID*Required Ex.) 09******** E-mail*Required Date of birth*Required Ex.) 1970/01/01 Zip code*Required Ex.) 606-8501 Address*Required Ex.) 46-29 Yoshida-Shimo-Adachi-cho, Sakyo-ku, Kyoto Course*Required FacultyMasterDoctorOther(Research Student etc.) Sex*Required MaleFemale Detail of the Overseas Travel Period*Required FROM - TO Ex.) 2014/04/01 Purpose*Required 1.Leisure2.Visit home3.Language Study4.Study5.Internship6.Japan Overseas Cooperation Volunteers7.Research8.Fieldwork9.Academic meeting10.Other If purpose nos.10 was selected, please provide specify. Country*Required Ex.) America City*Required Ex.) NewYork (If purpose nos.3-10 were selected, please provide further details.) Destination(s) Ex.) ****Univ. Please check the most appropriate entry: I intend to earn academic credits at Kyoto University during this trip.I intend to earn academic credits at the host institution during this trip.I do not intend to earn academic credits during this trip. Program Name*Required Please attach any relevant documents describing the program contents. Please use only alphanumeric file name. Scholarships, Sponsors, etc.*Required Emergency Contact in Japan during Period of Travel Name*Required Relationship*Required Telephone No.*Required Contact Details during Period of Travel E-mail Address Telephone No. Passport No. Travel Insurance Name of Insurance Company Futai kaigaku Name of Insurance Company (Except Futai kaigaku) Name of Insurance type Insurance No. You may leave above column blank if you buy "Futai kaigaku". Note1 ：Students who studies abroad are required to buy "Futai kaigaku"(Study abroad insurance coupled with "Gakkensai"). Detailed information is here(Japanese page only). Note 2: If you travel abroad for the purposes except for leisure or visiting home, we will register your travel information to the Japan IR&C Corporation’s risk management support system. Please check the registration notification email of the safety check app “Eye Finder” sent to you and use the service in a case of emergency. Please select your supervising professor or group teacher.*Required * Please get the permission of your travel from your supervising professor or group teacher before you submit this form. * Please select “Chairman of academic affairs” if you are a 4th year undergraduate and above who have not been assigned to any laboratories. Prof. ISHIHAMA (Chairman of academic affairs)Prof. TAKASU(Synthetic Medicinal Chemistry)Lect. TAKIKAWA(Synthetic Medicinal Chemistry)Prof. TAKEMOTO (Organic Chemistry)Assoc. prof. NAKA(Organic Chemistry)Prof. MATSUZAKI(Biophysical Chemistry)Assoc. prof. HOSHINO(Biophysical Chemistry)Prof. KATO(Structural Biology)Assoc. prof. OGAWA(Structural Biology)Prof. ISHIHAMA(Molecular Systems Bioanalysis)Assoc. prof. SUGIYAMA(Molecular Systems Bioanalysis)Prof. TAKESHIMA(Biologocal Chemistry)Assoc. prof. KAKIZAWA(Biologocal Chemistry)Prof. NAKAYAMA(Physiological Chemistry)Assoc. prof. SHIN(Physiological Chemistry)Lect. KATO(Physiological Chemistry)Prof. YAMASHITA(Drug Delivery Research)Assoc. prof. HIGUCHI(Drug Delivery Research)Assoc. prof. YONEZAWA(Clinical Pharmacy and Education)Prof. ONO(Patho-Functional Bioanalysis)Lect. WATANABE(Patho-Functional Bioanalysis)Prof. TAKAKURA(Biopharmaceutics and Drug Metabolism)Assoc. prof. TAKAHASHI(Biopharmaceutics and Drug Metabolism)Prof. KANEKO(Molecular Pharmacology)Assoc. prof. SHIRAKAWA(Molecular Pharmacology)Assoc. prof. HIRASAWA(Pharmacogenomics / Genomic Drug Discovery Sciences(GDDS))Prof. OHNO(Bioorganic Medicinal Chemistry)Assoc. prof. INUKI(Bioorganic Medicinal Chemistry)Prof. DOI(Systems Biology)Lect. YAMAGUCHI(Systems Biology)Prof. KAKEYA(System Chemotherapy and Molecular Sciences)Assoc. Prof. HATTORI(System Chemotherapy and Molecular Sciences)Assoc. Prof. ROBERT, Martin (Microbial Systems biology)Assoc. Prof. CAMPBELL, Douglas Simon (Neuronal Remodeling)Prof. YAMASHITA(Center for Integrative Education of Pharmacy and Pharmaceutical Sciences)Lect. TSUDA(Center for Integrative Education of Pharmacy and Pharmaceutical Sciences)Prof. KIMURA(Molecular Neurobiology)Prof. IGAKI(Genetics)Prof. OHMIYA(Fine Organic Synthesis)Prof. FUTAKI(Biofunctional Chemistry)Prof. TERADA(Clinical Pharmacy)Prof. OGATA(Integrative Genomics)Prof. MAMITSUKA(Computational Genomics)Prof. UESUGI(Chemical Biology)Prof. IKUTA(Immune Regulation)Prof. HASHIGUCHI(Medical Virology)Prof. ITO(Cell Fate Dynamics and Therapeutics) E-mail will be sent to your supervising professor automatically. (1)My supervising professor will accompany with my travel.*Required YESNO (2)Someone other than my supervising professor will accompany with my travel.*Required YESNO Please click the submit button after input characters written on the image above.