Reception No.
/
TOKAI COOL JAPAN TECHNOLOGY IN 2015
JAPANESE TECHNOLOGY & CULTURAL PROGRAM
Note: * means very important question.
1. Full Name in Roman block capitals*:
Paste photograph
here (taken within
3 months,
Nickname-,if you have one or if your given name is difficult to pronounce.* : 3cm x 4cm, color)*
Family Name
Given Name
Middle Name
*Your name card will be nickname.
We will put your
photo here.
2. Nationality*:
3. Gender*:
Male
4. Date of Birth* :
Female
(year)
(day) (Age:
(month)
now)
5. Passport Information: Passport Number*:
Date of Issue:
(year)
(month)
(day)
Date of Expiration:
(year)
(month)
(day)
6. Past Entry into Japan:
Yes
Time(s)(The latest entry: From
/
/
/
To
/
)
No
Year/ month/ day
year/month/ day
Address to which notification of acceptance and other information should be mailed.
7. Contact in your country*:
Address:
(City)
(Country)
Tel(Country code +～):+
Emergency cellphone: +
Fax. : +
Email address*:
(Zip code)
8. Name of your school/ institution/ company*:
If you are university student, major and grade*:
Ｕ
Ｍ
Ｄ
* U=Undergraduate, M=Master, D=Doctor
Major*:
Grade*:
(year)
Detail of your research*:
9. Are you a Muslim’s student? *:
Yes
10. Allergies or dietary(food) restrictions*:
No *If yes, we will take care your food and pray time.
Yes What kind?*
11. Cultural Programs (Check one of them) * :
Tea ceremony /
Japanese Calligraphy (Shodo)
12. Size of your Judo uniform:
13. Health condition:
Very good
Good
Other (
)
S size
M size
Not very good (Why?
L size
No
*The change is not acceptable.
LL size
, Medical requirements:
14. Purpose of study in Japan (multiple answers allowed) :
Technology lectures
Japanese Culture
Sightseeing
)
Other
15. Research and Future Plans*:
Explain how this study abroad experience relates to your research (major) and future interests or
career goals and what kind of experience you want to have in Japan.
16. English Level*:
Excellent
Good
Fair
Poor
(TOEFL/TOEIC/IELTS score
)
17. Japanese Level:
Excellent
Good
Fair
Poor
None
None
18. Read the important statement below, and check the box if you agree. We consider
submission of the application form to be an agreement to all rules and regulations of Tokai
University. *:
1.
2.
3.
Participants will be assigned double-quart rooms in the dormitory in the order that
applications are received. If the rooms are full, participants will be assigned to double
rooms in the faculty dormitory. The fees are the same for all room types.
Participants are expected to observe the rules and regulations of the dormitory.
Tokai University may use the photos taken during this program for advertisements.
I hereby verify the above information to be true and accept the conditions required.*
*Personal data entered in this application will only be used for the purposes of exchange program procedures, and contact information such as e-mail addresses will only be
used for sending of information by Tokai University.