学習院で学ぶ わくわくとしま日本語教室
受付 No.
2013 年
月
日
Application Form
（Hiragana／Katakana）
Name
（Kanji／Alphabet）
Gender
Address
□Male □Female
Birthplace(Citizenship）
Occupation
Contact Number
Date of birth
Phone：
19
.
.
e-mail：
Class（Please circle ○ the date(s) you wish to attend）
Wednesday
Thursday
Saturday （１）
１５：３０－１８：００
９：３０－１２：００
１４：００－１６：３０
Saturday （２）
１４：００－１６：３０
Nov. 20
Nov. 21
Nov. 23
Nov. 23
Orientation, Basic①（Greeting）
Orientation, Basic①(Greeting）
Orientation,
Subject【１】 ①Earthquake,
Typhoon
Subject【２】①Pharmacy
Subject【１】①Earthquake, Typhoon
Nov. 27
Subject【１】 ②Emergency
evacuation
Subject【１】 ③ Making
emergency phone calls
Nov. 28
Basic①（Greeting）
Orientation,
Basic①（Greeting）
Subject【２】①Pharmacy
Nov. 30
Nov. 30
Subject【５】 ①School events
Cultural experience 「Lunch box」
Basic② A flyer
Subject【２】 ②Seeing a doctor
Cultural experience 「Lunch box」
Basic③ Address
Dec. 4
Dec. 5
Dec. 7
Dec. 7
Basic③ Address （Repeat）
Subject【５】 ②School supplies
Subject【５】①School events
Basic④ A signboard
Subject【３】 ① Garbage
Subject【２】 ③Seeing a doctor
Subject【５】② School supplies
Subject【１】②Emergency
evacuation
Dec. 11
Dec. 12
Dec. 14
Dec. 14
Basic ⑤ Going shopping
Subject【５】③Contacting school1
Subject【５】③Contacting school 1
Basic⑥ Menu
Subject 【４】 At the post office
Subject【５】④Contacting school 2
Subject【５】④Contacting school 2
Subject【１】③Making emergency
phone calls
Q. Can you do the following in Japanese? Please tick the appropriate answer✓.
◎ Yes
○ to some extent
△ No
Use greetings such as ohayo, konnichiwa etc.
◎ ○ △
See a doctor at the hospital
◎ ○ △
Introduce yourself within 30 seconds
◎ ○ △
Ask about garbage disposal rules
◎ ○ △
Write your name in Japanese
◎ ○ △
Post a letter/parcel at the post office
◎ ○ △
Write your address in Japanese
◎ ○ △
Read a notice of non-delivery, and respond by phone
◎ ○ △
Read sign boards and understanding the content
◎ ○ △
Apply for re-delivery on the internet
◎ ○ △
Communicate with shop staff/shopping
◎ ○ △
Understand the times, content and purpose of events at
your child’ s nursery school or school
◎ ○ △
Read a menu, order food and drink
◎ ○ △
Prepare school supplies for class or events
◎ ○ △
Read a flyer and understand the content
◎ ○ △
Prepare a lunch box for a sports festival or a picnic
◎ ○ △
Use a machine to buy a food ticket
◎ ○ △
Contact school by phone or in writing
◎ ○ △
Understand earthquake, typhoon, and prepare necessary
items
◎ ○ △
Read handouts received from school and take action
◎ ○ △
Take suitable action when an earthquake or a fire occurs
◎ ○ △
Speak about your child with nursery teacher or teacher
◎ ○ △
Get information about an earthquake or typhoon on TV and
radio
◎ ○ △
Talk with other parents during school events
◎ ○ △
◎ ○ △
Participate in local community events and communicate
with Japanese people
◎ ○ △
◎ ○ △
Write all hiragana
◎ ○ △
◎ ○ △
Write all katakana
◎ ○ △
Make emergency phone calls
Explain medical symptoms and purchase medicine at the
pharmacy
Go to doctor/hospital and follow the procedure for
first-time patients
Fill in the medical questionnaire at the hospital
◎ ○ △
学習院で学ぶ わくわくとしま日本語教室（2013 年 11 月 20 日～12 月 14 日）
Japanese Class Subject (2013/Nov. 20～Dec.14）
１．Subject
Subject【１】Living Safely
① Preparing for earthquakes and typhoons
② Emergency evacuation, protecting
yourself
③ Making emergency phone calls
Subject【2】Living Healthy
① Going to a pharmacy
② Going to a hospital
③ Seeing a doctor
Subject【3】
The rules about garbage disposal
Subject【4】
Receiving postal items and home-delivered
parcels, responding to a notice of non-delivery
２．The cultural experience class（Nov. 30）
・Lunch box for school event
Subject【5】School
① School events
② Preparing school supplies
③ Contacting school by phone or in writing
④ Reading handouts
Subject【6】Basic Japanese
① Greeting
② Reading a flyer
③ Writing name and address and name
④ Reading signs
⑤ Going shopping
⑥ Reading a menu and ordering