Kansai University. Application Form for Japanese Language and Culture Course JLC. Form

Transcription

1 Form KansaiUniversity ApplicationFormforJapaneseLanguageandCultureCourseJLC PleasefillineitherinJapaneseorEnglishclearlywithblockletters Attachphotohere cm cm Full name in katakana or kanji Familyname Givenname Full name in alphabet FirstMiddle or Other Last Nationality Sex Male Female Dateofbirth Year MonthDay Passportnumber Dateofexpiration Year Month Day Telephone Fax Mailingaddress ofuniversity RegisteredprogramUndergraduate Masterscourse Doctoralcourse FacultyCourse Currentyearofstudy st year nd year rd year th year th yeargraduatedother Intendedstartofstudy fromapril fromseptember Termsofenrollment semestermonths semestersyear

2 Form UniversityDormitory Yespleasearrangemyroominthedormitory Iwillfindoffcampusaccommodationmyself SummaryofEducationalExperience Schools CityandCountry Yourageswhileattending Calendaryearsattended yearmonth JapaneseLanguageProficiency HaveyoustudiedJapanesebeforeYes No IfyeshowlonghaveyoustudiedJapanese aboutyears Months ExaminationforJapaneseUniversityAdmissionforInternational StudentsJapaneseasaforeignlanguageexceptwriting JapaneseLanguageProficiencyTest levelpassed pointsnevertaken pointsnevertaken JTest TestofPracticalJapaneseJTest levelpassed EnglishLanguageProficiency pointsnevertaken Nativelanguage TOEFL IELTS Others English Others PBT CBT ibt points Statementofpurposeforyourstudyabroad IfyouhavelearnedJapanesetrytowriteinJapanese points

3 Form ApplicantsDeclaration Ideclarethatallmystatementsinthisapplicationaretrue IhavereadandunderstoodtheAdmissionGuideforJLC IagreetojoinJapaneseNationalHealthInsuranceduringmystay IwillconformtoallUniversityregulationswhilestudyingatKansaiUniversity Signature Date year month day GuarantorSponsor Mustbefilledbytheguarantorsponsor ToThePresidentofKansaiUniversity Iwillbearfullresponsibilityincludingfinancialmatterfortheapplicant forthedurationofhisherstudiesinjlcatkansaiuniversity ofguarantorsponsor Tel Relationshiptotheapplicant E ofemployer Occupation Office Annualincome Signature Date year month day

4 Form KansaiUniversityCertificateofHealth TobecompletedinJapaneseorEnglishbytheexaminingphysician FamilyFirstMiddle Male Female DateofBirth yyyymmdd Age PhysicalExaminations Heightcm WeightKg BloodTypeABOABRh Hearing Normal Impaired EyesightRL R L withoutglasses withglassesorcontactlenses XrayExamination Musthavebeentakenwithinmonths lung normal impaired cardiomegaly normal impaired normal impaired incaseofcardiomegalyelectrocardiogram Describetheconditionofapplicantslungs Date PasthistoryPleaseindicatewith or andfillinthedateofrecovery Tuberculosis Malaria Othercommunicabledisease Epilepsy KidneyDisease HeartDisease Diabetes DrugAllergy Psychologicaldisorder FunctionalDisorderinextremities Yes Disease Diseasetreatedatpresent No IfyesdoeshesheneedtocontinuetakingmedicationortreatmentduringhisherstayinJapan Ifyespleaseprovidedetailedinformationregardingthemedicationortreatmentheshehasbeentaking Typeofmedicationtreatment Frequencytimes perweekperday Yes No Pleasedescribeyourimpression InviewofhishermedicalhistoryandabovefindingsisityourobservationhisherhealthstatusisadequatetopursuestudiesinJapan Yes No Date Signature Physiciansnameinprint OfficeInstitution

5 For applicant, part 1 Ministry of Justice, Government of Japan To the Director General of Regional Immigration Bureau Pursuant to the provisions of Article 7-2 of the Immigration Control and Refugee Recognition Act, I hereby apply for the certificate showing eligibility for the conditions provided for in 7, Paragraph 1, Item 2 of the said Act. Nationality/Region Date of birth Family name Given name Sex Male / Female Place of birth Marital status Married / Single Occupation Home town/city in Japan APPLICATION FOR CERTIFICATE OF ELIGIBILITY Year Month Day Cellular phone No. Passport Number Date of expiration Year Month Day Purpose of entry: check one of the followings "Professor" "Instructor" "Artist" "Cultural Activities" "Religious Activities" "Journalist" "Intra-company Transferee" "Business Manager "Researcher (Transferee)" "Researcher" "Engineer / Specialist in Humanities / International Services" "Skilled Labor" "Designated Activities ( Researcher or IT engineer of a designated org)" "Entertainer" "Student" "Trainee" "Technical Intern Training "Dependent" "Designated Activities (Dependent of Researcher or IT engineer of a designated org)" "Designated Activities(Dependent of EPA)" "Spouse or Child of Japanese National" "Spouse or Child of Permanent Resident" "Long Term Resident" "Highly Skilled Professional(i)(a)" "Highly Skilled Professional(i)(b)" "Highly Skilled Professional(i)(c)" Others Date of entry Year Month Day Port of entry Intended length of stay Accompanying persons, if any Intended place to apply for visa Past entry into / departure from Japan (Fill in the followings when the answer is "Yes") time(s) The latest entry from Year Month Day to Year Month Day Criminal record (in Japan / overseas) Yes ( Detail: ) / No Departure by deportation /departure order (Fill in the followings when the answer is "Yes") time(s) The latest departure by deportation Year Month Day Family in Japan (Father, Mother, Spouse, Son, Daughter, Brother, Sister or others) or co-residents Intended to reside Relationship Date of birth Nationality/Region with applicant or not Place of employment/school Regarding item 20, if there is not enough space in the given columns to write in all of your family in Japan, fill in and attach a separate sheet. In addition, take note that you are not required ed to fill in item 20 for applications pertaining to Trainee / Technical ca Intern Training. Note : Please fill in forms required for application. (See notes on reverse side.) Residence card number Special Permanent Resident Certificate number

6 For applicant, part 2 P ("Student") For certificate of eligibility Place of study of school Total period of education (from elementary school to last institution of education) Years Education (last school or institution) or present school Registered enrollment Graduated In school Temporary absence Withdrawal Doctor Master Bachelor Junior college College of technology Senior high school Junior high school Elementary school Others of the school Date of graduation or expected graduation Year Month Japanese language ability (Fill in the followings when the applicant plans to study at advanced vocational school or vocational school (except Japanese language)) Proof based on a Japanese language test of the test Attained level or score Organization and period to have received Japanese language education Organization Period from Year Month to Year Month Others Japanese education history (Fill in the followings when the applicant plans to study in high school) Organization and period to have received Japanese language education / received education by Japanese language Organization Period from Year Month to Year Month Method of support to pay for expenses while in Japan Method of support and an amount of support per month (average) Self Yen Supporter living abroad Yen Supporter in Japan Yen Scholarship Yen Others Yen Remittances from abroad or carrying cash Carrying from abroad Yen Remittances from abroad Yen of the individual Date and time of Others Yen carrying cash carrying cash Supporter Occupation (place of employment) Annual income Yen

7 For applicant, part 3 P ("Student") For certificate of eligibility Relationship with the applicant (Check one of the followings when your answer to the question 26(1) is supporter living abroad or Japan) Husband Wife Father Mother Grandfather Grandmother Foster father Foster mother Brother / Sister Uncle / Aunt Educational institution Friend / Acquaintance Relative of friend / acquaintance Business connection / Personnel of local enterprise Relative of business connection / personnel of local enterprise Others Organization which provide scholarship (Check one of the following when the answer to the question 26(1) is scholarship) Foreign government Japanese government Local government Public interest incorporated association / Others Public interest incorporated foundation Plans after graduation Return to home country Enter school of higher education in Japan Find work in Japan Others Actual guardian in Japan( Fill in the following if the applicant is to study at a junior high school or elementary school ) Relationship with the applicant Cellular Phone No. Applicant, legal representative or the authorized representative, prescribed in Paragraph 2 of Article 7-2. Relationship with the applicant Cellular Phone No. I hereby declare that the statement given above is true and correct. Signature of the applicant (representative) / Date of filling in this form Year Month Day Attention In cases where descriptions have changed after filling in this application form up until submission of this application, the applicant (representative) must correct the part concerned and sign their name. Agent or other authorized person Organization to which the agent belongs