※denotes mandatory fields.

Read the “Terms and Conditions”, “Program Participant Declaration of Health and Disclaimer” and
“Program Participant Declaration and Pledge”on the website and check the boxes to acknowledge agreement.
Agreement 01

Agreement 02

Agreement 03

Name (same spelling as your passport)
Family Name
Middle Name(If you have)
Given Name/First Name
Family Name
Middle Name(If you have)
Given Name/First Name
Gender(Same as your passport)
Date of Birth
Day〔Date of Birth〕
Month〔Date of Birth〕
Year〔Date of Birth〕
Home Address
Address Line 1

(street address, apartment, unit#…)
Address Line 2

(City, State, Province, Region…)
Address Line 3

(Postal Code, Zip, Country)
Email Address
Email Address(再入力/Re-enter)
Emergency Contact’s Full Name
Emergency Contact’s Phone
Emergency Contact’s Email Address
Emergency Contact’s Email Address(再入力/Re-enter)
Do you have any serious health problems including allergies to animals, medicines, etc. or asthma?
Do you have any dietary restrictions? If yes, give details.
Is Halal food required?
Is Praying Room required on campus?
Home Institution (your current school or workplace)
Major Field of Study
How did you find out about this program?

Extra information (if any) you would like us to know
Ⅰ. Japanese Language Proficiency
(1) Have you ever studied Japanese before?
Hours of Study:
Place of Study:
Name of School:
Name of Textbook:
(2) Japanese proficiency level
①JLPT (approx.): the level of
②Can you write Hiragana and Katakana?
③How many Kanji can you read?

Approx. ( )Characters
④How many Kanji can you write?

Approx. ( )Characters
⑤Mother tongue language:
⑥Language Proficiency Level (based on self evaluation)
Japanese Speaking
Japanese Listening
Japanese Reading
Japanese Writing
English Speaking
English Listening
English Reading
English Writing
Ⅱ. Describe your studies and/or special interests about Japan.
Division of International Affairs
Kyoto University of Foreign Studies