The 15th Kamenori Awards                                                  Reception No.                .                  
Application Form                                                              Individual or Organization 
(To be filled by the Foundation) 
1/8          
      
The Kamenori Foundation 
The Kamenori Foundation          
  ★ ☆ The 15th Kamenori Awards ☆ ★  
Application Form 
* The private information above will be used for the selection of the Kamenori Award. Please note that it may also be 
used for Kamenori Foundation’s publicity including media releases to newspapers  
▲Individual or Organization Applicant  
□ Individual     □ Organization    （Please check the box that applies） 
 Name of Organization  
Corporate Status： Yes（                     ） ・ No     
（For Individual 
 Applicants） 
Individual Name   
Applying Category  *Please check ✓ for applying award. 
□ Kamenori Grand Award 【Grassroots】 □ Kamenori Grand Award 【Human Resource Development】 □ Kamenori Pioneer Award 
History of Past Application 
*Please indicate if you have applied in  the past. 
Year Applied  ： 
 〒      - Address    Phone Number             
E-mail address 
ＦＡＸ                        
Website URL    
Representative Name of Organization Occupation/Appointment  
＊ In the case you are chosen for the award, the organization name or individual name will be written on the award 
plaque, so please enter the official and correct name.   
 Contact Person 
Name of Contact Person Occupation/Appointment 
Contact Personnel Information （Email address, Phone number, FAX number）    
The 15th Kamenori Awards                                                  Reception No.                .                  
Application Form                                                              Individual or Organization 
(To be filled by the Foundation) 
2/8          
      
The Kamenori Foundation 
 ◇Considerations for filling out the form◇ For each item, please include concrete numbers and names. For those who have been awarded in the past and are applying again, please enter the activities that have taken place after receiving the award, with the exception of ③-a “Timeline of activities” where all activities should be listed.   (Examples) ・We established the international education volunteer network, “XX Net”, consisting of about 40 foreign citizens and about 60 Japanese citizens in 1995. ・In order to nurture international understanding through education, we collaborated with XX’s city educational committee and international exchange association. ・We are in charge of a program in which foreign citizens and international exchange students in Japan 
(from ten universities, including X, Y, and Z Universities) give over 60 hours’ worth of international education lectures at six local elementary schools per year. We also provide translation services for OX Prefecture’s advertisements (for Chinese, Korean, English).  
・We aim for multicultural cooperation through exchanges between Japanese and foreigners at a local level by having Japanese citizens provide foreign citizens with counseling and consulting regarding raising children and issues regarding everyday life.                                                     Ⅰ．Contributions Made Through Current Activities 
① Activities and Aim (Describe characteristics, such as a catch-phrases, within 400 words） 
② Organization / Individual 
【Composition】 Number of Overall Members:  （Staff :               Official Members :              Volunteers :                ）   【Years of activity】          years           【Frequency of activities】  ___________ ＊Beginning year of activities:  From  ____________  【Location of Activities】（Enter locations within or outside Japan）    【Income and Expenses】 Previous year： Income                 (JPY)     Expenses               (JPY)    Income and Expenses Balance              (JPY)   Fundraising Methods （Please check）： □ Contributions from members     □ Donations     □ Funds □ Others （Please describe：                                            ） 【Honors】    
The 15th Kamenori Awards                                                  Reception No.                .                  
Application Form                                                              Individual or Organization 
(To be filled by the Foundation) 
3/8          
      
The Kamenori Foundation 
Ⅱ Regarding activities: Please describe in simple bullet point form.  
【Please describe in simple bullet point form】  Main Activities (up to 5, especially in Asia / Oceania) and the achievements and results of those activities. 
    Activity Description / Achievements and Results * Please enter the description, number of participants, countries involved and volunteer ratio of the activities. Please also enter past connections developed with the local community, how you have developed collaborations, co-operations, and the sharing of know-how in the past, and how you will develop them in the future. 
Comments and Feedback 
from the Recipients 
* Please enter as much information as possible about the affiliation, name, age group and nationality of those who provided the comments and feedback. 
①                  
②                       
The 15th Kamenori Awards                                                  Reception No.                .                  
Application Form                                                              Individual or Organization 
(To be filled by the Foundation) 
4/8          
      
The Kamenori Foundation 
<Cont.>Activity Description / Achievements and Results Comments and Feedback 
from the Recipients 
③                 
④                 
⑤               
The 15th Kamenori Awards                                                  Reception No.                .                  
Application Form                                                              Individual or Organization 
(To be filled by the Foundation) 
5/8          
      
The Kamenori Foundation 
Ⅲ．Future target and vision （Activities and expansion of the project） 
【Please describe in simple bullet point form.】 
＊Please describe the future target and vision, how you will develop your project/activity, what is your next plan of 
new project, how to raise funds in a future, etc. 
                    
 Ⅳ．The activity that you most focused on over the past year and its results.  
＊Please write the reasons why this was the most prioritized activity over the last several years and what kind of 
actions were taken for it. Please also appeal your pioneer activities if you have engaged on. 
                    
The 15th Kamenori Awards                                                  Reception No.                .                  
Application Form                                                              Individual or Organization 
(To be filled by the Foundation) 
6/8          
      
The Kamenori Foundation 
Ⅳ．Free Space (This information will help you gain points)    【Please describe in simple bullet point form.】 
① Please freely enter any information regarding activities you held, such as youth exchanges and educational 
programs among Asian countries, different districts, and any other people-oriented activities.  
・       ・       
② Please enter any activities you have taken part in to tackle any issues that arose due to the coronavirus pandemic. 
 * If most of your activities were related to the pandemic, please enter it in the “II Regarding activities” section.  
・       ・       
Ⅴ．Photo showing activities  
* If there is a blog or other websites that posts pictures of your activities, please enter the website address.  
* If there is no blog or website, please attach a A4 size page of pictures with explanations to the application under 
 the title “VI. Pictures that demonstrate activities.” 
Blog or Website Address ：        
The 15th Kamenori Awards                                                  Reception No.                .                  
Application Form                                                              Individual or Organization 
(To be filled by the Foundation) 
7/8          
      
The Kamenori Foundation 
☆ If awarded with the Kamenori Award, what would you use the activity subsidy for?           
☆ What is your motive for applying for the Kamenori Award?             ☆ How did you find out about the Kamenori Award?  
Please describe the concrete source of information. Ex) Website of volunteer center of city A/ Poster on the International Exchange Association in prefecture B            
The 15th Kamenori Awards                                                  Reception No.                .                  
Application Form                                                              Individual or Organization 
(To be filled by the Foundation) 
8/8          
      
The Kamenori Foundation 
☆ Checklist of documents to submit  
Note: Please add a ☑ next to the documents submitted and include this sheet with the other documents.  
Documents 1 through 4 are required, so please be sure to include them. For document 4, please include either ① or ②. 
 Check 
Documents Check 
Confirmation 
１ □ Application Form (This sheet) 
□ Did you check to make sure all information is entered? 
Did you add the extra document for those submitting the “VI. Photo showing activities” on a separate document? 
２ □ Letter of Nomination 
Did you download the form from our website and have a well-informed third-party person fill it out? 
□ Did the reference person for the recommendation form sign or stamp the document? 
３ □ Letter of Confirmation 
□ Did you download the form from our website and check the contents? 
□ Did you sign or stamp the form? 
①  Printed “Group Information / 
Group details” page on the  CANPAN website. 
□ Is your information disclosure level ★4 or higher? 
(If level★3 or lower, submit ②） 
□ Did you include the most recent project proposal and budget plan? 
□ Did you include the project report and financial statement of the past two years? 
②  If ① is difficult to obtain, please 
include the below: 
・The most recent project proposal  and  
budget plan. 
・The project report and financial 
statement of the past two years 
□ Did you include the most recent project proposal and budget plan? 
□ Did you include the project report and financial statement of the past two years? 
* If these documents are not available, please submit 
documents that provide similar information.  
５ □ Any document that briefly describe the content and activities (e.g., Brochures)  
６ □ Documents that demonstrate the outcome of the activities (e.g., project reports, questionnaires) 
７ □ Document describing of any new projects, especially those scheduled for next year, if any. 
Please list up any other documents you included in your application ・ ・                                               
Please refer to the “Frequently Asked Questions” section on our website  
for more information on the Kamenori Awards 
https://www.kamenori.jp/kamenorishou.html 
Date:           /        / 2021 