Application form for Home visit
Date: May.26th.sat , Jun.2nd.Sat (half day or one night stay)
Contact: International Student Office: E2-109, iso@office.uec.ac.jp

Please DO NOT Leave the cell blank for "*" marked questions. (You have to fill in “Nothing" or " N/A” in that case.)

Email address *
Name *
Your answer
Student ID No. *
Your answer
Nickname
Your answer
Mobile No.
Your answer
Nationality *
Your answer
Age *
Your answer
Sex *
Please choose your preferred dates for home visit (plural choices)./参加を希望する日を全て選択してください。 *
Required
Please fill in languages in which you can communicate./簡単な会話のできる言葉を全て記述してください。 *
Your answer
Do you have any restriction of food or drink ?/ 飲食に制限はありますか。 *
Your answer
Do you prefer to drink alcohol?/ お酒は好きですか。 *
Your answer
Do you have any allergies of food or animal ?/食べ物や動物の毛にアレルギーはありますか。 *
Your answer
Do you prefer playing with children? /子供と遊ぶのは好きですか? *
Please introduce yourself. (Let us know your hobby like sports, favorite movies, music…etc) How do you like to spend in spare time?/具体的な自己紹介をしてください。(趣味、関心、スポーツ、好きな映画、音楽など) *
Your answer
What kind of activity do you hope with host family?/ホストファミリーとしたいことはありますか? *
Your answer
Do you have any other comments?/その他、何かあれば書いてください。
Your answer
Please email us your photo for introduction to host family./ホストファミリーへ紹介するための写真をメールで送ってください。[the subject should be "home visit"] *
A copy of your responses will be emailed to the address you provided.
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