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
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1 Application Form for Global Studies Course 2015 Basic Information 基 本 情 報 Name 氏 名 Last Name First Name Gender 性 別 Nationality 国 籍 Date of Birth 生 年 月 日 /Month/Date Male Age 年 齢 Female Applicant Information Home Address (Include Country of Residence) 現 住 所 Telephone Number 電 話 番 号 Address メールアドレス 歳 Name of the School Currently Enrolled 在 籍 の 学 校 名 Parent/Guardian Information Name 氏 名 Home Address (Include Country of Residence) 現 住 所 Telephone Number 電 話 番 号 Address メールアドレス Last Name First Name Relationship to the applicant 受 験 者 との 関 係 Same as above Personal information entered in this form will only be used for the application process.
2 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 Month Month No. of s 修 業 年 数 Month Month Month 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 母 語
3 D) Japanese language Proficiency 日 本 語 能 力 Japanese language ability in daily life 日 常 的 な 日 本 語 能 力 話 す 力 Speaking 書 く 力 Writing 読 む 力 Reading 聞 く 力 Listening 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 取 得 年 月 日 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 書 く 力 Writing 読 む 力 Reading 聞 く 力 Listening
4 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 IELTS TOEFL PTE CAE TELP Total (Average) Score 得 点 取 得 年 月 日 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
5 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 s 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 s Programme (PYP), the Middle s 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.
6 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:
7 Check list of the documentation to be included in the application Application form (Download from the school website) Certified copies of evidence of English and/or Japanese ability Verification letter of current school in attendance Certified copies of full-academic transcript from Junior High School translated into English or Japanese Information outlining the topic areas and academic skills covered in Mathematics and Science in the current school year and translated into English or Japanese Letter of recommendation from a current teacher Essay in English or Japanese (details below) Certified copy of passport Certificate from learning institute which shows your Japanese language learning history
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