THE NIPPON CLUB
Culture Courses
145 West 57th Street, 6 Fl.
New York, NY 10019
(212) 581-2223 / culture@nipponclub.org
REGISTRATION FORM – Winter 2016
JF Japanese Language Course at The NIPPON CLUB Culture Courses
Last Name (Please print or type.)
Address
Home Phone
First Name (Please print or type.)
Apt.
City
State
Cell Phone
Zip
Email
@
I would like to register for:  A1-1 Introductory Japanese (1/20 –3/23, WED. 6:15 – 7:15 pm)
$200
 A1-1 Introductory Japanese (1/14 – 3/24, THU. 6:15 – 7:15 pm)
$200
 A1-2 Introductory Japanese (1/14 – 3/24, THU. 7:30 – 9:00 pm)
$300
 A1-3 Introductory Japanese (1/20 – 3/23, WED. 6:30 – 8:00 pm)
$300
 A2-2 Elementary Japanese (1/14 – 3/24,
THU. 6:00 – 7:30 pm)
$300
 A2-4 Elementary Japanese (1/14– 3/24 ,
THU. 7:40 – 9:10 pm)
$300
WED. 7:30 – 9:00 pm)
$300
MON. 6:30 – 8:00 pm)
$300
 A2/B1 Pre-Intermediate Japanese
(1/20– 3/23,
 B1 Intermediate Japanese (1/11 – 3/28,
Registration Fee:
 Nippon Club member
$25
*first time only
 Employee of Nippon Club/JCCI member company
$30
 Non-member
$50
* If you are not sure about your membership type, call (212) 581-2223.
To register, please complete this form and submit by mail or in person to:
The Nippon Club Culture Courses
145 West 57th St., 6Fl, New York, NY 10019
(Please make your check payable to “The Nippon Club”).
*The office is open Mon - Fri: 10am - 5pm.
*Payment by cash or check only. (No credit card).
*IMPORTANT!
Notice:
Registration deadline is three (3) business days prior to the first class meeting.
- Full payment for tuition and fees must accompany your registration.
- Class may be cancelled due to insufficient enrollment by the registration deadline.
- Refunds are not available after the first class starts.
Please turn over
First survey
Your name: ____________________________________
1. What is your first language?
2. Do you know any language(s) other than your first language? If yes, please name all of them and
rate your proficiency level of each language (i.e. beginner, intermediate-low, intermediate-high,
advanced-low, advanced-high, near-native level etc.).
3.
Have you ever been to Japan?
□ No
□ Yes
When:
How long:
Where:
Purpose:
4. Have you studied Japanese before?
□ No
□ Yes
When:
How long:
How :
(Please specify the names of institution(s), textbook(s) and chapters covered, and/or websites you used)
5. Have you ever taken any official Japanese language proficiency tests (ex JLPT, ACTFL OPI, AP
Japanese etc.)? If yes, please elaborate in detail (when you tried what, and the result of each
exam).
6. What are your purposes/goals in studying Japanese? Please check all that apply.
□ to learn what Japanese language/cultures are like.
□ to travel in Japan somewhat comfortably.
□ to communicate with your friends/family on simple daily topics.
□ to communicate with your friends/family on social/academic topics.
□ to have business communication.
□ to understand TV dramas/movies.
□ to read newspaper/watch TV news.
□ Other(s)
7. What aspects of Japanese culture are you interested in?
(Check all of the boxes that apply and provide examples)
□ Arts (ex.
)
□ Literature (ex.
)
□ Food (ex.
)
□ Anime/manga (ex.
)
□ Music (ex.
)
□ Fashion (ex.
)
□ Movie (ex.
)
□ Other (Please specify.
)
8. How did you find out about the JF Japanese language course?
□ Chopsticks New York
□ Time Out New York
□ Email from Japan Foundation, NY
□ Japan Foundation, NY website
□ Email or pamphlet from Nippon Club
□ Facebook
□ Newsletter from the Japan Foundation, NY
□ Newsletter from the Nippon Club
□ Word of Mouth
□ Web search
□ Poster (where:
□ Other (
)
)
Please turn over
9. Please indicate the reason(s) you got interested in JF Japanese Language Course at The Nippon
Club Culture Courses. Check all that apply.
□ Location
□ Schedule
□ Class level
□ Class contents
□ Cost
□ Instructors
□ Related cultural events
□ Other: Please specify below.
____________________________________________________________________________
____________________________________________________________________________
10. Is there anything that motivated you to sign up at this particular time? If yes, please provide
more detail.
Example 1: I’ve been interested in Japanese language for a long time, and I finally have time to
manage it.
Example 2: I’m traveling to Japan soon.
Example 3: It’s a good season for me to start something new!
____________________________________________________________________________
____________________________________________________________________________
11. (Optional) What is your age group?
□ Under 18
□ 18-29
□ 30-44
□ 45-59
□60 or older
12. (Optional) What is your current occupation?
13. Any comments or message?
Thank you very much for your time!