Personal Information


* = Mandatory

Title

First Name (*)

Middle Name

Last Name (*)

Nick Name(if any)

Your Name in Japanese <カタカナ>

Date of Birth(*)

Year Month Date

Nationality(*)

E-Mail Address(*)

Your Current Mailing address(*)

Street
City/Town
State/Province
Country
Zip/Postal Code

Phone Number(*)

Name of Home University(*)

Year at the University(*)

Your expected date of graduation(*)

/

ENGLISH PROFICIENCY

Is English your first language?

If your answer is "NO", are you able to understand lecture conducted fully in English?

Indicate your TOEIC, TOEFL and IELTS score and the date of the test.


Your health condition.

Tell us your health conditons.

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

If yes, please describe the name of the medicine

Please make sure to bring enough amount of medicine that covers your length of stay in Japan. Foreign prescriptions are not acceptable at the pharmacies in Japan and you are required to go to see a doctor first to purchase the prescribed medication.

(2) History of past illness(*)

If Yes, please describe in detail. Example: Anxiety, Depression, ADHD, any major surgeries, etc.

(3) Present health condition

Please describe in detail if any current disease or disorder is present. Example: Anxiety, Depression, ADHD, PTSD, Pneumonia,
Tuberculosis, Diabetes, etc.

(4) Please indicate any special dietary, medical requirements, or allergies you have.

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.

* If you answered "YES" for (1). or wrote some conditions on (3), please attach your doctor's note including sentences that approves your participation for this program.

Emergency Contact Information(*)

Emergency Contact Person
Relationship
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
Test

Upload your documents(*)

Please upload those all required documents to complete your application. File sizes must be less than 5 MB each.

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

Please select your favorite accommodation

Note: Due to the large number of RSJP2 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%.

Int'l House TAISHOGUN(Quad) Chrysantheme(Single) Chrysantheme(Twin)
JPY 60,900 JPY 156,700 JPY 156,700
1st favorite 2nd favorite 3rd 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.