University of Adelaide

Jan. 08 to Feb. 01, 2019

Due date; Thursday, November 01, 2018

Personal Information

* = Mandatory


First Name (*)

Middle Name

Last Name (*)

Nick Name(if any)

Date of Birth(*)

Year Month Date

E-Mail Address(*)

Phone Number(*)

Year at the University of Adelaide(*)

Your expected date of graduation(*)


Your health condition.

Tell us your health conditons.

(1) Do you take medicine regularly?(*)

Please indicate any physical or mental concerns if you have any

ex) Special dietaries(Halal, Vegan, Vegetarian), Food Allergies, Gender, wheelchair, learn disorders, etc

In a Japanese culture activity, you will have a chance to cook and eat Japanese food. Since fish and many different kinds of ingredients are used for Japanese food even soup stock, please mention your dietary information if you have any.

Also, please consider that you get a flue shot before you leave for Kyoto. Due to local regulations, if you get the flue, you will be asked stay in your room at least 5 days and it will cost your extra fees. It is not mandatory.

Emergency Contact Information(*)

Emergency Contact Person
E Mail
Phone Number

Education Background(*)

Japanese Language Courses in Progress or Completed(*)

List the following information for each formal Japanese Language Courses you have or will completed.

Please let us know your physical hours, not credit hours, minutes or number of days.

Class Name Physical Hours From To Institution
hours / /
hours / /
hours / /

If you have studied Japanese outside of university, (such as in high school or at a language school) please list the course(s) you have taken including hours of study and the name of the institution.

Please list all the text books you have used, including the chapters of each book you have completed.(*)

Textbooks Competed Chapters
Japanese Language Proficiency(*)

Speaking Listening Reading Writing

Japanese Language Proficiency Test
Test Level Score Year
New Test

Your inform us your favorite accommodation.

You can find details about lodgings(Click here)

Most favorite Second favorite Third favorite

Please note: We are unable to guarantee your favorite room.

I don't mind if I stay in a Triple. Expect reduce my lodging fee.

Your YUKATA choice

To arrange your YUKATA during the program.

Your height Your hip size Your foot size
cm cm cm

Which color would you like to wear?

Upload your documents(*)

Please upload those all required documents to complete your application.

Transcript(jpg/pdf) Photo(jpg/pdf) Essay(jpg/pdf)
Passport(jpg/pdf) Consent(jpg/pdf) Health Certificate(jpg/pdf)

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