2017International Student Program Application Form

MEIJI GAKUIN UNIVERSITY

2017International Student Program Application Form

Please Type or Print Clearly

ENROLLMENT INFORMATION

Desired year of admission: ______

Desired period of study: (check one)Paste your recent

_____ First Semester Only (April-July)photograph here

_____ Second Semester Only (September-January)

_____ Academic Year (April-January)

_____ Academic Year (September-July)

University Currently Attending:Applicant's Level: Freshman, Sophomore, Junior, Senior

PERSONAL DATA

Full Legal Name ______

Last (Family or Surname)FirstMiddle

Birthplace ______Birthdate _____/_____/_____ Present Age _____

City Country Month Day Year

Gender _____ Male _____ Female Country of Citizenship ______

Permanent home address ______

Street and Number

______

City State or Province Country Zip/Postal Code

Tel ______E-Mail ______

Present mailing address ______

Street and Number

______

City State or Province Country Zip/Postal Code

Tel ______E-Mail______

EDUCATIONAL DATA

Please list below all high schools, colleges, and universities you have attended.

Name of SchoolLocation Dates attended Degree_____

______

What is your major field of study where you are currently enrolled? ______

LANGUAGE

Are you an applicant from a university in the country where the official language is English?

Yes______, No______

If not, you are required to answer following questions.

JAPANESE LANGUAGE EXPERIENCE

1)Howmany years /semesters have you studied Japanese language?______

2)Where did you study Japanese?(List institution and course)

______

ENGLISH LANGUAGE TEST INFORMATION

TOEFL/IELTS Score ______

ACADEMIC HONORS

Briefly describe any scholarships or awards you have received:

______

PROFESSIONAL OR PRACTICAL EXPERIENCE

List all your significant work experience and community involvements (volunteer activities):

______

REFERENCES

List two persons from whom you will request letters of recommendation regarding your qualifications for participating in this program:

1) ______

Title and NameInstitution

Address ______

Street and Number City

______

State or Province Country Zip/Postal Code

2) ______

Title and NameInstitution

Address ______

Street and Number City

______

State or Province Country Zip/Postal Code

GUARDIAN/FINANCIAL SPONSORINFORMATION

Full Name ______

Last (Family or Surname) First Middle

Address ______

Street and Number City

______

State or Province Country Zip/Postal Code

Telephone ______Fax ______

Occupation ______Company/Organization ______

Any other persons to be notified in case of an emergency: (give names, addresses, and phone numbers)

______

______

CERTIFICATION

I hereby certify that all statements made in my application are correct. I further agree to submitting all other supplemental documents as requested.

______

Signature Date