2013-2014 Application for Admission

Kwansei Gakuin University Japan and East Asia Studies Program

The deadlines for this application and supporting materials are as follows: Fall Semester: April 15, 2013 / Spring Semester: December 15, 2013 Note: Information provided on this form will be used for university administrative purposes only and be held strictly confidential. The University will take full responsibiltiy for the storage and disposal of this data.

Photo 3 cm x 4 cm full-face taken within the last 3 months

Personal Information (

Legal Name in Alphabet:

Last/Family First Middle Preferred

Legal Name in Katakana:

Last/Family

First

Middle

Preferred

Legal Name in Kanji, if Applicable:

Sex:
Last

First

Female

Male

Nationality:

Date of Birth:
Country of Citizenship (Passport) Day Month Year

Birthplace:

City, Country

Present Mailing Address: Include Your Full Address

Postal Code/ZIP

Tel

Fax

Address Effective Until:

Country Day Month Year

How often do you check your e-mail?

E

E-mail Address (the one you check the most often)

E

Permanent Address:

Include Your Full Address Postal Code/ZIP Tel Fax

Country

Period of Study and Affiliation (/)

Please choose your intended period of study at KGU and current level of study in your home university:

Intended Period of Study:

Current Level of Study:

Level of Study During Exchange

Choose the Undergraduate or Graduate School; closest to your major, with which you would like to be affiliated:

Undergraduate/Bachelor:

Graduate/ Master/Professional Only:

Module Choice (
Please choose the module which you would like to follow during the Japan and East Asia Studies Program: Module:

Please consult the Japan and East Asia Studies Program brochure for information regarding the modules, and carefully make your choice. You will not be able to switch modules during your period of study at KGU.

Japanese Language Assessment Report (is required from your Japanese language instructor as part of this application. Please have the instructor seal and sign the envelope containing the completed report and return it to you to send together with your application materials. Assessment Report completed by:

Name:

Title:

Affiliation:

Previous Stay(s) in Japan (

If you have stayed in Japan previously, please provide the following information :

From:

Until:
Month Year Month Year Year Location Purpose

From:

Until:
Month Year Month Location Purpose

Emergency Contact Person (

Full Name:

Relationship:

Tel (Home):

Tel (Mobile):

Fax:

E-mail:
E

Address:

Include Full Address Postal Code/ZIP Tel

Country

Education (
Please list below in chronological order all schools you attended, beginning with elementary school:

Names and Locations Schools Attended

Dates of Attendance

Did you Graduate?

Present School:

Year(Standing):

Expected Graduation:
Month Year

Major(s):

Address:
Include Full Address Tel

School Sending you to KGU (if different from above):

(

Address:

Include Full Address

Tel

I certify that to the best of my knowledge, all statements herein and all supporting documents are correct, complete, and my own.

After saving this file to your hard drive, please print and sign one copy and submit it to your exchange coordinator along with all other supporting documents.

Signature :

Date

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