IC-NS

Granting the Use of the Name “The Japan Foundation” as a Supporter

Application Form

To the President of the Japan Foundation:

Date:
Applicant
Name of Applicant:
(nama pemohon/pelamar)

Street Address:
(alamat)

Country Phone: Fax:

Email:　　　　　　　　　　　　　　　　　　　　　　　Website:

Type of Applicant: ( Please refer to item 2 of the Guidelines ) Year of Establishment

(jenis pemohon/pelamar) (tahun pendirian)

Name of the Representative of Applying Organization: (Title) (Signature)

(nama perwakilan organisasi yg melaksanakan)
Mr.
Ms.
Dr.
Please circle one of the above.

Phone: Fax: Email:

Name of Project Director (Contact Person of the project): (Title)

nama direktur proyek
Mr.
Ms.
Dr.
Please circle one of the above.

Phone: Fax: Email:

Project
Title of Project:
Nama proyek

Category a. Performances (pertunjukan), exhibitions (pameran), film screenings (pemutaran film),

lectures (perkuliahan), conferences (konferensi), seminars and competitions (seminar dan
perlomaan)
b. Personnel exchange (pertukaran personil)

c. Production and distribution of documents (produksi dan distribusi dokumen)

d. Other international cultural exchange projects(proyek pertukaran budaya yg lain)

Please circle one of the above.

Purpose and description of the Project:
(ujuan dan deskripsi proyek)

Dates : Venue(s):
　　　　　　　　 　～　　　
(day/month/year) 　　　　　　 　(day/month/year)
Names that may be used as a supporter : (Please circle one of the following)
(nama nama yang bisa diguakan sebagai pendukung)
a. The Japan Foundation
b. The Japan Foundation China Center
c. The Japan Foundation Center for Global Partnership
d. The Japan Foundation Asia Center
e. The Japan Foundation Japanese-Language Institute, Urawa
f. The Japan Foundation Japanese-Language Institute, Kansai
g. The Japan Foundation Kyoto Office
h. The Japan Foundation Overseas offices (The Japan Foundation Jakarta)
i. The Japan Foundation Center for Global Partnership (New York)
Types of Support: Please circle one of the following.
Jenis dukungan
a. Support b. Cooperation c. Others
Support Please list other organizations which you have applied to or have been authorized for the
from Other nominal and other types of support:
Institutions (mohon daftar organisasi lain yang telah anda ajukan atau telah diberi wewenang untuk jenis
(dukungan dukungan nominal dan lainnya
dari institusi
lain) (Name of Institutions) (Type of Support)
Yes / No
Event(s) or project(s) related to the applying project ( if any ):
(acara2 atau proyek yang berhubungan dengan proyek yang didaftarkan

Please attach following documents:

1. Detailed information about your organization such as type of organization, background and aims,
organizational
chart (detail of board members, number of members, etc.), historical overview, past activities, financial
status,
articles of association and annual reports
Informasi rinci tentang organisasi anda seperti jenis organisasi, latar belakang dan tujuan, struktur
organisasi (detail anggota dewan, jumlah anggota, dll.), gambaran historis, aktivitas lampau, status
keuangan,
anggaran dasar dan laporan tahunan

2. Detailed plan of the project above ( including the financial plan )

(rencana rinci mengenai proyek) (termasuk rencana keuangan)