APPLICATION (2/5)

    2. STUDENT INFORMATION

    Please write names exactly as they appear on the passport.

    Last Name

    First Name

    Middle Name (if applicable)

    Gender
    MaleFemale

    Date of Birth

    Nationality

    Other Nationalities (if applicable)

    Place of Birth

    Student Email (if applicable)

    Student Phone Number (if applicable)

    Address in Japan

    First Language

    Second Language

    Other Languages (if applicable)

    Enrollment Year

    Enrollment Date

    Grade of Entry

    Campus

    English Skill (0: None ~ 4: Above Grade Level)
    Listening 01234
    Speaking 01234
    Reading 01234
    Writing 01234

    English Qualifications (Eiken / TOIEC / GTEC etc) (if applicable)

    Japanese Skill (0: None ~ 4: Above Grade Level)
    Listening 01234
    Speaking 01234
    Reading 01234
    Writing 01234

    Student Photo
    (File Type: jpg,jpeg,png,pdf / File Size: ~5MB)

    Student Passport
    (File Type: jpg,jpeg,png,pdf / File Size: ~5MB)

    3. PREVIOUS SCHOOL INFORMATION

    School Name

    School Phone

    School Email

    School Address

    Grades Attended

    Enrollment Date

    Withdrawn Date

    Report / Transcript From Current or Previous Year (if applicable)
    File Type: jpg,jpeg,png,pdf,doc,docx,pages / File Size: ~5MB