[별지1호서식] [Attached Form No. 1]

실험실(연구실)운영지원비 기관 지정 신청서

Application Form for Designation of Institution Eligible to Avail Funding for Operation of Laboratory (Research Lab.)

1. 실험실(연구실)운영지원비 대상 과제 현황 Profile of the Research Assignment Eligible to Avail Funding for Operation of Laboratory (Research lab.)

(단위 Unit:천원 1,000KRW)

연구책임자 Principal Investigator	과제번호 Research No.	과제기간 Research Period		연구비 Research Funds(현금 Cash)	간접비 Indirect Costs
		과제시작일 Start Date	과제종료일 End Date

2. 실험실(연구실)운영지원비 지정금액 Amount Earmarked for Operation of Laboratory (Research lab.)

(단위 Unit:천원 1,000KRW)

과제번호 Research No.	실험실(연구실)운영지원비 Funds for Operation of Laboratory (A)	기 사용액 Amount Already Expended (B)	잔액 Remaining Amount (C=A-B)	지정액 Amount Earmarked (D)

3. 실험실(연구실)운영지원비  지정 현황 Profile of Allocation of Funds for Operation of Laboratory (Research lab.)

(단위 Unit:천원 1,000KRW)

지정기관 및 지정 금액 Designated Institution and the Amount Earmarked					지정 후 잔액 Remaining Amount after Allocation
( ) 단과대학 College(a)	( ) 학과 Department(b)	( ) 연구소 Research Lab.(c)	( ) 기타 Other(d)	합계 Total(D)

※지정기관별 지정금액의 합계(a+b+c+d)는 2.실험실(연구실)운영지원비 지정금액의 지정액(D)와 일치 The sum of the amount earmarked for each institution (a+b+c+d) shall be the same as the amount earmarked (D) described in 2. Amount Earmarked for Operation of Laboratory (Research lab.).

※지정 후 잔액은 2.실험실(연구실)운영지원비 잔액(C)에서 지정액(D)를 차감한 금액임. The remaining amount after allocation is calculated by subtracting the amount earmarked (D) from the remaining amount (C) specified in 2. Amount

4. 실험실(연구실)운영지원비 지정사유 Reason for Designation as an Institution Eligible to Avail Funding for Operation of Laboratory (Research Lab.)

위와 같이 실험실(연구실)운영지원비 기관 지정 신청서를 제출합니다.

I hereby submit the Application Form for Designation as an Institution Eligible to Avail Funding for Operation of Laboratory (Research Lab.)

년    월    일

MM DD, YYYY

연구책임자 Principal Investigator:          (인 Seal)

제주대학교산학협력단장 귀하

Messrs. Director, Jeju National University Industry-Academic Cooperation Foundation