Keio Short-Term Japanese Studies Program

Keio Short-Term Japanese Studies Program

Application Form

Spring2018

ATTACH PHOTO

HERE

(taken within 6 months, 3cm x 4cm, color, glossy)

Instructions:

A)Applications should be typed or printedclearly inblock letters.

B)Years should be written using the Western calendar.

C)Check the appropriate boxes.

1. Full Name

Family Name / First Name / Middle Name
Use only the Englishalphabet.
Do not use characters with accent marks
(e.g. ą, ç, ë).*

*Our data system does not recognize characters with accent marks.

1. Date of Birth (yyyy/mm/dd) 3. Gender Male Female

19 ×× / mm / dd / Age / 4. Nationality

1. Home Institution

Name of your home institution / Expected date of graduation
20 ×× / mm / dd
Study Level
□ Undergraduate □ Graduate / Major / Minor / Year-level
Faculty/Graduate School

6.Contact Details

Mailing Address
Tel. +
Fax. + / E-mail

7.Emergency Contact Details (Must be different from the above)

Full Name / Relationship to the Applicant
Mailing Address
Tel. +
Fax. + / E-mail

CONTINUE TO THE NEXT PAGE 

8.Education (Most recent academic history including high school)

Name of Institution / Major / Location / Period (yyyy/mm) / Degree earned
yyyy / mm ～yyyy / mm
yyyy / mm ～yyyy / mm
yyyy / mm ～yyyy / mm
yyyy / mm ～yyyy / mm

9.Questions

A) Have you been to/studied in Japan?
If “yes,” pleaseprovide us the details of your previous stays. / Yes No
Location / Period of stay (yyyy/mm) / Purpose
B) Does your nationality require you to obtain a visa to enter Japan? / Yes No
*We strongly recommend that you check with your nearest Japanese Embassy for information on what kind of documents are required for your visa application.
C) Please indicate your Japanese proficiency. / None Beginner Intermediate Advanced
*Japanese language skills are not required to apply for this program.
*First-time Japanese language learners (Please check “None” above.) are to attend the “Survival Japanese,” whereas the rest are to join other Japanese language activities.

10.Statement of purpose

On a separate sheet, please explain why you would like to participate in this program and what you would like to achieve from it. The statement should be less than 250 words, typed or written clearly.

11.Complete the Online-Registration

12.Read the statement belowand sign if you agree

-I certify that the information given in this application is complete and accurate to the best of my knowledge, and if admitted,

I agree to comply with the rules and regulations of Keio University.

-I understand that students are expected to be punctual at all times and to participate in ALL classes and activities scheduled for the program.

Date:
20 ×× / mm / dd / Applicant’s Signature:

(Year) (Month) (Day)

13.✔Checklist: The application must include ALL of the following documents.

□1. Application form (this form)
□2. Statement of purpose
□3. Transcript (A photocopy of a grade report or a downloaded copy of a transcript is acceptable, as long as it includes all your coursework and grades.If it is issued in a language other than English, attach an English translation.)
□4. A copy of your passport (the page including your photo)
*This will also be submitted to the hotel where participants will stay during the program.
□5. An extra set of copies of all the documents above.

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