Seinan International Student
Ambassador Network

Registration Form

Registration Form
Seinan International Student Ambassador Network

  • Application
  • Confirmation
  • Completion

* Please be sure to input the items marked with.

1. Name
Last (Family) Name
First (Given) Name
Middle Name
Name in KataKana (if any)
2. Gender
3. Date of Birth
Month     Day     Year 
4. Nationality
5. Country of Residence
6. State of Residence
7. Current Address
8. E-mail Address
9. Home institution when you attended the program
10. Program you attended
11. Year of the Program
12. Name of Workplace
13. Type of Business
14. Position
15. Comment


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