LUJ Open College Application Form
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Full Name (漢字) if applicable
Family Name (姓・ローマ字) *
First Name (名・ローマ字) *
Nationality (国籍)
Gender (性別)
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Postal Code (〒) *
Home Address (ご住所 ) *
Home Phone (ご自宅 TEL)
Mobile Phone (携帯電話)
Email (Eメール) *
Company Name (勤務先)
How did you learn about the Open College program? (本学のオープン・カレッジをどこで知りました?) *
I am interested in attending one of the Information Sessions on: (開講講座説明会(無料)に参加します) *
For those eligible, please select a category to help determine your Open College discount.
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If applying for the Mentor Discount, please write the names of the recipient(s) you are introducing. (紹介割引をご利用の方は、ご紹介者様のお名前をご記入下さい)
1st choice for an Open College class  (受講希望クラス) *
2nd choice for an Open College class  (第2希望クラス) *
3rd choice for an Open College class  (第3希望クラス) *
I acknowledge I have read and understand the Open College Policies, and hereby consent to those policies. *
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This form was created inside of Lakeland College Japan.