Intensive Summer Course
HIROSHIMA and PEACE 2018
Hiroshima City University
Please complete and return by April 13, 15:00 JST, 2018 to Hiroshima-and-Peace@office.hiroshima-cu.ac.jp
APPLICATION
Personal Information
Family
Name:
Given
Name:
Middle
Initial:
Date of Birth:
(dd/mm/yy)
Gender:
Female / Male
Citizenship:
Language:
Native
Mailing Address:
Official letters and transcript will be sent to this address.Phone:
Email:
Academic Information
Name of the
Institution:
Major/
Field of Study:
Current Status
(1)
undergraduate
student:
Entered in
(year
)
(2)
graduate
student:
Entered in
Master level student / Doctoral level student (NOTE: Please circle one)(year
)
(3)
occupation:
Degree earned ( ) in (year ) Name of the Institution ( )
Reference
Name of a Professor or Supervisor who could serve as a reference:
Institution and Department: