Personal Information


* = Mandatory

Title

First Name / Given Name(*)

Last Name / Surname (*)

Nick Name or 汉字”hànzì(if any)

Date of Birth(*)

Year Month Date

Nationality(*)

E-Mail Address(*)

Current mailing address

Street (*)

City / Town

State/ Province/ Prefecture(*)

County

Zip/ Postal code

Phone Number(*)

Your University / College(*)

Year at the University(*)

Your expected date of graduation(*)

/

Emergency Contact Information(*)

Emergency Contact Person
Relationship
E Mail
Phone Number


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.

Education Background

Japanese Language Courses in Progress or Completed

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

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 if any.

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

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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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