Application Form for Global Studies Course 2015
◆Basic Information 基本情報
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Name 氏名Last Name First Name Gender
性別 Nationality 国籍 Male Female
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Date of Birth 生年月日 Year/Month/Date Age 年齢 歳 Home Address (Include Country of Residence) 現住所 Telephone Number 電話番号 Email Address メールアドレス Name of the School Currently Enrolled 在籍の学校名P
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Name 氏名Last Name First Name Relationship to the
applicant 受験者との関係 Home Address (Include Country of Residence) 現住所 □Same as above Telephone Number 電話番号 Email Address メールアドレス
◆Educational Background 学歴
List in chronological order, all schools you have attended
Name of School 学校名 Date of Entrance
入学年月 Date of Graduation/leave 卒業年月 No. of Years 修業年数
Year Month Year Month
Year Month Year Month
Year Month Year Month
◆Language Background 言語について
A) English study background (Including schooling) 英語学習歴（学校も含む）
Name of Institute 教育機関または学校名 Country 国 Duration of Studying 学習期間
B) Japanese study background (Including schooling) 日本語学習歴（学校も含む）
Name of Institute* 教育機関または学校名 Country 国 Duration of Studying 学習期間
*Please attach a certificate which shows your Japanese language learning history along with this application form. A minimum period of one year studying is required when applying a Visa to study in Japan.
一年以上日本語教育を受けたことがわかる証明書を添付してください。
C) Home use 家庭での言語
Languages spoken at home 家庭で話す言語
Language which you recognize as your mother tongue
D) Japanese language Proficiency 日本語能力
○Japanese language ability in daily life 日常的な日本語能力
○Japanese Language Proficiency Test<JLPT> 日本語能力検定試験
Please fill out the following form if you have taken the Japanese Language Proficiency Test <JLPT> before. And also attach the original or certified copy of your result. 過去に日本語能力試験を受験したことのある者は 以下を記入してください。また合否結果通知または日本語能力認定書を添付してください。 Level 取得級 Score 得点 Year 取得年月日 Year Month
E) English language Proficiency 英語能力
○English language ability in daily life 日常的な英語能力 話す力 Speaking □母語レベル Native □ 優 Excellent □ 良 Good □ 可 Fair □ 不可 Poor □能力なし No Knowledge 書く力 Writing □母語レベル Native □ 優 Excellent □ 良 Good □ 可 Fair □ 不可 Poor □能力なし No Knowledge 読む力 Reading □母語レベル Native □ 優 Excellent □ 良 Good □ 可 Fair □ 不可 Poor □能力なし No Knowledge 聞く力 Listening □母語レベル Native □ 優 Excellent □ 良 Good □ 可 Fair □ 不可 Poor □能力なし No Knowledge 話す力 Speaking □母語レベル Native □ 優 Excellent □ 良 Good □ 可 Fair □ 不可 Poor □能力なし No Knowledge 書く力 Writing □母語レベル Native □ 優 Excellent □ 良 Good □ 可 Fair □ 不可 Poor □能力なし No Knowledge 読む力 Reading □母語レベル Native □ 優 Excellent □ 良 Good □ 可 Fair □ 不可 Poor □能力なし No Knowledge 聞く力 Listening □母語レベル Native □ 優 Excellent □ 良 Good □ 可 Fair □ 不可 Poor □能力なし No Knowledge
○English as a second language standardized test 英語能力検定試験
Please fill out the following in relation to one ESL standardized test result. And also attach the original or certified copy of your result. 以下の英語能力試験の得点を記入してください。また、成績を証明できる 結果通知書を添付してください。
Test (Circle one test you have taken) テストの種類
Total (Average) Score 得点 Year 取得年月日 IELTS TOEFL PTE CAE TELP Year Month
◆Personal detailed information 個人に関する質問
○Health/ Personal matters (which school needs to be aware of) 学校が注意すべき病歴や健康状態など
○Hobbies/Special interests 趣味/好きなことなど
○Family 家族 Name 氏名 Relationship 続柄 Age 年齢 Occupation 職業
◆Accommodation 滞在先
All international students at Eisugakkan must live in our school dormitory unless they have family or guardians within reasonable commutation time from the school. If you plan to live outside of our dormitory, please fill the form below.
Address
Name of person you will live with
Relationship Contact information
◆Course selection コース選択
Choose the course you would like to apply for
□Global Studies E ( English DP stream course )
□Global Studies J ( Dual language DP stream course )
Eisugakkan is a candidate school* for the International Baccalaureate (IB) Primary Years Programme /Diploma and pursuing authorization as an IB World School.
*Only schools authorized by the International Baccalaureate can offer any of its four academic programmes: the Primary Years Programme (PYP), the Middle Years Programme (MYP), the Diploma Programme or the IB Career-related Programme (IBCP). Candidate status gives no guarantee that authorization will be granted.
Note:
- Students entering Eisugakkan are required to obey the school regulations.
- Students who have any special dietary requirements will need to supply and prepare their own meals. *Cooking is not allowed in the dormitories.
◆Career
※If you have thought about universities, please list your area of interests and countries you want to study in, after Japan. Area of interest 希望学部 Country 国 上記に記した情報すべて相違はありません。
I confirm that the information herein is complete and correct; Applicant’s Signature: _________________________
Parent/Guardian’s Signature: _________________________ Date: ________________
