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APPLICATION FORM
FOR
2024 SEINAN SUMMER JAPANESE PROGRAM

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I. Applicant's Information

1. Name
* Last (Family) Name
* First (Given) Name
Middle Name
* 2. Gender
  
* 3. Date of Birth
Month     Day     Year 
* 4. Nationality
5. Passport Number
* 6. E-mail Address (Indicate the one which you will use in Japan)
* 7. Current Residential Address
* 8. Current Phone Number
9. Permanent Address (If different from Q7)
* 10. Have you visited Japan before?
  

If yes, please provide us with the details of your stays. (e.g. location, period of stay, purpose)
* 11. Emergency Contact Information
Name
Relationship to Applicant
Phone Number
Address
Email Address

II. Academic Background

* 1. Name of University/College

2. Major
3. Year in School (as of June 2024)
              
4. Degree
        
* 5. Please give us a brief description of your secondary education.(e.g. name of high school, month of graduation, etc.)

III. Health and Medical Information

* 1. Do you have any learning differences (e.g. amblyopia, dyslexia)?
  

If yes, please indicate.  
* 2. Do you have any allergies or other medical requirements?
  

If yes, please indicate.  
* 3. Have you ever received treatment or counseling for mental issues?
  

If yes, please indicate.  
4. If you have any pre-existing medical conditions (including mental issues), please give details.

IV. Language Proficiency

* 1. What is your native language?
* 2. Have you passed any recognized Japanese language test (e.g. JLPT, JPT, EJU)?
  
If yes, please indicate the name of the test and the score/level.
* 3. Have you passed any recognized English language test (e.g. TOEFL, IELTS)?
     
If yes, please indicate the name of the test and the score/level.

V. Previous Japanese Studies

* 1. Have you studied Japanese at any educational institution for at least ONE semester (at the time of the application), OR possess an equivalent of the above-mentioned education?
  
* 2. Please provide us with the history of your Japanese language studies.
1) Secondary Education
Period of Study
e.g. “from August 2020 to present, total 3 years 4 months”
from  to  , total  years  months
Class Hours (per week)
e.g. “90 min class × 2 time(s) (per week)”
min class ×    time(s)
Name of Textbooks
e.g. “Genki (I)”
Volume
e.g. “Volume 2”
Lesson
e.g. “Up to Chapter #”
2) University/College
Period of Study
e.g. “from August 2020 to present, total 3 years 4 months”
from  to  , total  years  months
Class Hours (per week)
e.g. “90 min class × 2 time(s) (per week)”
min class ×    time(s)
Name of Textbooks
e.g. “Genki (I)”
Volume
e.g. “Volume 2”
Lesson
e.g. “Up to Chapter #”
3) Other
Period of Study
e.g. “from August 2020 to present, total 3 years 4 months”
from  to  , total  years  months
Class Hours (per week)
e.g. “90 min class × 2 time(s) (per week)”
min class ×    time(s)
Name of Textbooks
e.g. “Genki (I)”
Volume
e.g. “Volume 2”
Lesson
e.g. “Up to Chapter #”

  

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