First Name
Local Address
Permanent Address
High School
M.I.
NATIVE SPEAKER
Last Name Email
Zip
Zip
Local Phone
( )
Permanent Phone
( )
Transfer Student
Yes No
Previous University (Name and Address)
9-digit Student Identifier
Major Minor (if any) Class Year
UMass Honors
Yes No
Gender
M F
List all appropriate language courses you have taken or are currently taking.
Course# Course Title Year Taken Institution/Address
As a member of the Japanese Language Program you will be assuming academic responsibilities in addition to your regular course load. Consequently, it is important that you be a student in good standing. Please indicate your GPA to date: ______
Please describe other relevant education or experience (i.e. study/travel/living/working abroad, fluency in an additional language, language spoken in home).

3.
2.
1. Why do you want to be in this Language Program? What do you expect to learn?
What makes you a suitable candidate for this program?
List name and department of two references (i.e. your advisor, one instructor from the language department).
Date: Student Signature:
PLEASE RETURN COMPLETED APPLICATION (ALL 3 PAGES) TO
RESIDENTIAL ACADEMIC PROGRAMS, 101 THATCHER, UMASS, AMHERST, MA 01003

Native Speaker
I request admission to the Thatcher House JAPANESE Language Program as a native speaker participant. I agree to participate in the JAPANESE Language Program for the entire academic year, September-May, and I understand that exceptions to this year-long commitment can be made only for a study abroad semester.
I understand and agree to the following:
1) I will enroll in the 2-credit JAPANESE 285 conversation/culture course each semester, which involves academic work appropriate for a 2-credit course as determined by the JAPANESE
Department.
2) I will speak JAPANESE as much as possible with other participants in the program.
3) I will be given a room assignment based on available space on the appropriate floor for my language.

No double single rooms can be guaranteed. The Program reserves the right to fill any empty space at any

point during the year.
Under special circumstances, my room assignment can be changed because of changing population in the
overall Language Program.
4) I will be a "good citizen" of the Thatcher community, which includes adhering to all the rules of the residence
hall. I understand that if I break residence hall rules I may be dismissed from the Program.
5) I will be a responsible and active member of the JAPANESE 285 class, which includes:
 attending all classes, on time, according to the expectations stated in the course syllabus
 preparing class assignments to meet specified deadlines
 taking an active role in the class as well as in related activities and programs outside class
6) I will be a responsible and active member of the overall JAPANESE Language Program, which includes:
 being responsible and considerate as a member of the floor community and as a roommate
 speaking JAPANESE as much as possible with fellow participants
 taking part in program-related activities as part of the community of JAPANESE speakers
I agree to notify the Residential Academic Programs office, 101 Thatcher House, in writing or in person if I wish to withdraw from the program and I understand that I will be assigned to another residence hall based on available space.
By my signature, I agree to abide by these requirements and I understand that I may be dismissed from the Thatcher
House JAPANESE Language Program if I break any part of this agreement.
Name:____________________________________________________________
PLEASE PRINT CLEARLY
Student Number:___________________________________________________
Signature:_________________________________________________________Date:____________