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[]
["別記様式1"]
[null,null,null,null,null,null,null,null,"受付番号"]
[null,null,null,null,null,null,null,"２０　　年　　月　　日"]
[]
[null,"放射線災害・医科学研究拠点トライアングルプロジェクト　申請書"]
[]
[null,"放射線災害・医科学研究拠点本部長　殿"]
[]
[null,null,null,null,null,"申請者","所属"]
[null,null,null,null,null,null,"職名"]
[null,null,null,null,null,null,"氏名"]
[null,null,null,null,null,null,"メールアドレス"]
[]
[null,"トライアングルプロジェクトに下記のとおり申請いたします。"]
[]
["申請テーマ\n(いずれか一つにチェック)"]
[]
[]
["申請研究名称\n(和文・英文両方を記入）",null,null,"（和文）"]
[null,null,null,"（英文）"]
["研究概要(500字以内)"]
["他の拠点機関研究者の\n所属及び氏名",null,null,"氏　　名",null,null,"所属機関",null,null,null,null,null,"職　名"]
[]
[]
[]
[]
[]
["協力者（拠点機関が属する大学に所属する他部局研究者に限る。）の有無"]
[null,null,null,"氏　　名",null,null,"所属機関・部局",null,null,null,null,null,"職　名"]

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