LUJ Open College Application Form
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)
Clear selection
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.
Clear selection
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. *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Lakeland College Japan.