DATE: July 01, 2019 to July 13, 2019
Check in: June 30, 2019
Check out: July 14, 2019
Program fee: JPY 105,000
Accommodation fee: JPY 55,146 or JPY 66,700

Personal Information

* = Mandatory


First Name / Given Name(*)

Last Name / Surname (*)

Nick Name(if any)

Your Name in Japanese <カタカナ>

Date of Birth(*)

Year Month Date


E-Mail Address(*)

Current mailing address

Street (*)

City / Town

State/ Province/ Prefecture(*)


Zip/ Postal code

Phone Number(*)

Your University / College(*)

Year at the University(*)

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.

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 Completed Chapters
Japanese Language Proficiency(*)

Speaking Listening Reading Writing

Japanese Language Proficiency Test
Test Level Score Year
New Test

Upload your documents(*)

Please upload those all required documents to complete your application.

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

Please select your favorite accommodation

Note: Due to the large number of applicants, we are currently experiencing an accommodation shortage. RU will arrange your accommodations for the program from one of the choices listed, but please understand that placement at your highest choice is not guaranteed.
Due to our regulation and safety reasons, you may not change your accommodation or room with the other participants. The withdrawal of the program after the accommodation booking and its payment made may cause cancelation charge of 100%.

Accommodation Coop Inn KYOTO(Single) SEED IN KYOTO(Twin)
Room rate per person JPY 66,700 JPY 55,416
Web sites Coop Inn Seed In
1st favorite 2nd favorite

Please download and read our "Matter of Observed" and sign before you upload it.

I hereby declare that the information provided is true and correct. I also understand that any willful dishonesty may render for refusal of this application or immediate termination of participation.

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