The 27th Japanese Language Speech Contest of Quebec
REGISTRATION FORM
Instructors must email registration forms to the Consulate General of Japan in Montreal by 5 p.m. on February 19, 2016 (Friday).
1.
FORMAT
2.
CATEGORY
☐NOVICE *
☐BEGINNER
☐INTERMEDIATE
* Not included in the National Japanese Speech Contest. See Contest Rules for details.
3.
NAME (English)
☐DIALOGUE/SKIT FORMAT *
☐REGULAR
Name in English
(Katakana)
DIALOGUE/SKIT FORMAT: Group representative’s name:
☐ADVANCED
☐OPEN
Name in Katakana
(Kanji)
Name in kanji
Representative name
# of members
#
For the Dialogue/Skit Format, please note that each group member must submit their own form.
AGE
Age
ADDRESS
(must be 18+)
SEX
☐M
☐F
NATIONALITY:
☐Non-Japanese
☐Dual including Japanese
Postal Code
Address
Tel.
E-mail
(000) 000-0000
Postal Code
Email
4.
NAME OF UNIVERSITY/INSTITUTION
NAME OF CURRENT INSTRUCTOR
5.
JAPANESE LANGUAGE STUDY BACKGROUND Please include hours to be taken until March 12, 2016 for the Quebec contest.
☐Novice (less than 75 hrs)
☐ Beginner (less than 130 hrs)
School or Study Method
School or Study Method
School or Study Method
School or Study Method
6.
TITLE OF SPEECH
☐ Intermediate (260 hrs max)
From (mm/yyyy)
mm/yyyy
mm/yyyy
mm/yyyy
TIME SPENT IN JAPAN SINCE THE AGE OF SIX
☐Novice (3 mths max)
☐ Beginner (3 mths max)
From (mm/yyyy)
mm/yyyy
mm/yyyy
mm/yyyy
7.
Name of University/Institution
Name of Current Instructor
To (mm/yyyy)
mm/yyyy
mm/yyyy
mm/yyyy
To (mm/yyyy)
mm/yyyy
mm/yyyy
mm/yyyy
(English)
# of Hours
Hours
Hours
Hours
☐ Intermediate (6 mths max)
Duration
Duration
Duration
Duration
☐ Advanced (no limit)
☐ Open (no limit)
Total before March 12, 2016
Hours hours
☐ Advanced (3 yrs max)
☐ Open (no limit)
☐ Not Applicable
Total: Years
years
Months
months
Days
days
Title of Speech in English
(Japanese)
Title of Speech in Japanese
Participant names and speech titles will appear in program as they appear on application form. Any corrections must be requested by instructors via email to
culture@mt.mofa.go.jp. Changes in speech titles will not be accepted once the contest material preparation has begun (only correction of errors will be accepted).
8.
APPROXIMATE DURATION
9.
HAVE YOU PREVIOUSLY TAKEN PART IN A JAPANESE LANGUAGE SPEECH CONTEST?
Minutes
minutes
QUEBEC
☐No
☐YesWhich category? Check all that apply.
NATIONALS
☐No
☐YesWhich category? Check all that apply.
10. PARTICIPANT’S DECLARATION
☐Novice
☐Beginner
☐Intermediate
☐Advanced
☐Open
☐Beginner
☐Intermediate
☐Advanced
☐Open
☐By checking this box, I declare that the above information is complete and true.
Date
Date
11. INSTRUCTOR’S VERIFICATION
Instructor’s Initials
Initials
This form has been checked by the Instructor
☐Yes, Received on:
Date
Date
/
Time
Time