application form.xls

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1	HIS Japanese Language Program Application Form
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3	Please fill out the information below and return this form to HIS at jlp@hiroshima-is.ac.jp or fax to (082)843-6399.
4	You will then be contacted for setting up a lesson schedule.
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7	(Student Information)
8	Name	□Mr. □Ms.
9	Nationality		Assignment terms
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11	(Home Information)
12	Address
13	Phone No.		Fax No.
14	E-mail
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16	(Work Information)
17	Company name
18	Address (location)
19	Phone No.		Fax No.
20	E-mail
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22	(Lesson Information)
23	Teacher's name
24	Lesson frequency	1, 2, 3 times/week	Lesson hours	Total hours/week
25	Lesson schedule	Days	Hours	Time
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28				~
29	Lesson start day		Lesson location
30	Intensive course	Yes (Dates: ~ )		No
31	Textbook
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33	(Questions)
34	1. What are your goals? What do you want to learn?
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37	2. How much time can you devote to studying?
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40	3. Do you have any Japanese language capabilities?
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43	4. Other comments?
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