Application Please enable JavaScript in your browser to complete this form.Email *Personal and Contact InformationName *FirstLastShown in your national identification documentSex *MaleFemaleDate of Birth *Country of Citizenship *Country of Residence *Primary Phone *MovilHomeWorkCountry Code *Phone Number *LinkedInWrite the URL of your profileDo you have a disability? *YesNoMirai Innovation does not discriminate against people with physical or learning disabilities. We strive to provide all participants with the required resources so they are able to excel in the programs.In case you have a disability, describe it.Academic BackgroundProvide the link of your CV *Upload your CV in English to your preferred cloud service such as Dropbox or Drive and copy/paste the link. Please make sure the PDF file has public access permission. Not LinkendInName of school or institution you belong to *Name of institution and location (city/country)What is your main academic major? *Other studies with certification or official recognition such as summer courses, seminars, workshops or diplomatIn case you are a student, specify which semester are you currently enrolled in?Write a list of your participation in challenges, contests and volunteerism if anyWrite a list of your principal awards and distinctions if anyIf you have a web site where we can appreciate your work, for example, github or other, write the URL here.do you have academic publications? *YesNoWrite your list of publications if anyLanguageWhat is your level of English language? *A0/A1 English (Beginner/Elementary)A2 English (Pre Intermediate)B1 English (Intermediate)B2 English (Upper Intermediate)C1 English (Advanced)C2 English (Proficient)Do you have any English certification? *YesNoList your certifications. MIRI ProgramThe program duration is from 4 to 12 weeks. How many weeks would you like to participate with us in Japan? *4 weeks5 weeks6 weeks7 weeks8 weeks9 weeks10 weeks11 weeks12 weeksWhen is your estimated arrival date?Do you have a pre-defined research topic? *YesNoI would like to define my research topic with Mira Innovation research staffIf you have a pre-defined research topic, write the title here.Who will pay for the program fee and travel expenses in Japan? *My parentsI will pay using my own financial resourcesOther institutionMy universityA fundraising campaignI will try to find a scholarshipOtherIf your answer is 'other', specify here.How did you learn about Mirai Innovation Research Internship Program - MIRI?I confirm that all of my responses are complete, true, correct, and accurate. I certify that all responses are my own thoughts, ideas, and words and do not contain plagiarism. *I confirmFull name as signature *Fields with (*) are compulsory.SubmitSave and Resume Later Your form entry has been saved and a unique link has been created which you can access to resume this form. Enter your email address to receive the link via email. Alternatively, you can copy and save the link below. Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted. Copy Link Email * Send Link
