Select Your Plan (Select in BOLD Letters)

Application form – Kyoto Japanese Summer Experience
30thJune – 22th July 2018 in Kyoto University of Foreign Studies
- How to apply -
1.Please fill in this form. (※denotes mandatory fields)
2.Send acompleted application formand apassport copy to
- Schedule -
Application deadline: 19th March 2018
Notification of selection result will be emailed after 22nd March2018with payment link (Credit Card).
Payment deadline: 30th March 2018
Accommodation details notification: June 2018

※Select your plan (Select in BOLD letters)

Plan A <JPY 240,000> / Plan B <JPY 270,000*Please note that there will be JPY 5,000required for credit card transaction fees.

Applicant’sinformation

※Familyname: / (Middle Name): / ※First name:
(Your full name in KATAKANAカタカナ):
※Gender: / ※Nationality: / ※Date of Birth: / ※Age:
※Address: / ※City
※State/Province: / ※Country: / ※Zip/Postal Code:
※Phone1:+ / (Phone2):+ / ※Email:

Emergency contact (Guardian’s information)

※Familyname: / (Middle Name): / ※First name:
※Gender: / ※Nationality: / ※Date of Birth: / ※Gender:
※Address: / ※City
※State/Province: / ※Country: / ※Zip/Postal Code:
※Phone1:+ / (Phone2):+ / ※Email:

※Do you need a VISA to stay in Japan for 3 weeks? (Select in BOLD letters)

Yes / No

Health/Allergies

Do you have any serious health problems including allergies to animals, medicines or asthma?
(if any):

Please also tell us about any dietary restrictions you have

※Current school/occupation (Select in BOLD letters)

Student

Working professional

Other

Name of institution: / Company name: / Specify:
Major/Course: / Designation:

※How do you know about this program? (Select in BOLD letters)

Japanese community at University (Name: )

Japanese language school that you attend (Name: )

Magazine (Name: )

Facebook

Other(Specify: )

Note or message you would like us to know

(if any)

Japanese Language Proficiency (Select in BOLD letters)

※Have you studied Japanese before? /

Yes (How long?: (hrs.)) (Which school? : ) (Which textbook: )
No

※Do you have any JLPT qualification? /

Yes (Level: )(When did you take the test? : )
No (What JLPT level do you think you are at now?:N1/N2/N3/N4/N5/Zero)

If you have otherJapanese language proficiency qualification,
(Please specify: ) (When did you take the test? : )

※Can you write Hiragana? (Select in BOLD letters)

Yes 2. No

※Can you write Katakana? (Select in BOLD letters)

Yes 2. No

※How many Kanji can you read? (Approx.)

( ) Characters

※How many Kanji can you write? (Approx.)

( ) Characters

※What is your mother tongue?

Language Proficiency Level based on self-evaluation (Select in BOLD letters)

※Japanese Speaking