7-1 Ohgigaoka, Nonoichi, Ishikawa 921-8501 JAPANKIT Japanese Language Program (JLP) Summer 2023
Student Information & Background in Japanese
PLEASE NOTE
1) All information provided in this form will be treated in strict confidence.
2) Red boxes are mandatory fields.
1. NameOther names you go by::

2. Major:

3. Minor (if applicable):

4. Year in school: _____(year)

5. Native language(s):(as appears on your passport)(if different from above)□Undergraduate■□Masters

6. Previous Japanese language study (Please include Japanese courses

you are planning to take before the program.)

If none, check here

□PhD.

:□[Formal Japanese Study]i. Where
When

Grade received
Textbook used

ii. WhereWhen

Grade received
Textbook usediii. Where
When

Grade received
Textbook used

iv. Where
When

Grade received
Textbook used

□Elementary school□Junior high school□University (Name:□Other (Name:
Semester & Year (e.g. Fall 2019)
□A
□B
□C
□D
□Other(e.g. Genki 1: ch1-6)□High school□Elementary school□Junior high school□University (Name:□Other (Name:Semester & Year (e.g. Fall 2019)□A□B□C□D□Other(e.g. Genki 1: ch1-6)□High school□Elementary school□Junior high school□University (Name:□Other (Name:Semester & Year (e.g. Fall 2019)
□A
□B□C
□D
□Other(e.g. Genki 1: ch1-6)□High school□Elementary school□Junior high school□University (Name:□Other (Name:Semester & Year (e.g. Fall 2019)
□A
□B
□C
□D
□Other(e.g. Genki 1: ch1-6)□High school))))■1))))

7-1 Ohgigaoka, Nonoichi, Ishikawa 921-8501 JAPAN[Self-study]i.

MethodProgram name /Book nameii.

When started
How long(e.g. June 2019)(e.g. to present)

Method□Online course□Self-study using books□Other (Program name /Book nameiii.

■When started
How long(e.g. June 2019)(e.g. to present)

Method□Online course□Self-study using books□Other (Program name /Book nameiv.

□Online course□Self-study using books□Other (When started
How long(e.g. June 2019)(e.g. to present)

Method□Online course□Self-study using books□Other (Program name /Book nameWhen started
How long□Private lessons□Podcast)□Private lessons□Podcast)□Private lessons□Podcast)□Private lessons□Podcast)(e.g. June 2019)(e.g. to present)

7. Please give an honest self-evaluation of each of your skills in Japanese.
(On a scale from 1 to 10: 1 being a complete beginner and 10 being native-speaker)
Reading ________, Writing ________, Speaking ________, Listening ________
8. Have you ever been to Japan?
If yes, for how long in total?

□Yes

□No

9. Do you have any contact with native speakers of Japanese outside of class?
□Yes□NoIf yes, who?

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7-1 Ohgigaoka, Nonoichi, Ishikawa 921-8501 JAPAN

10. Do you have any family members who are Japanese?
□Yes□No
If yes, what is their relationship to you?
11. How did you become interested in taking Japanese courses?

12. What is your objective for studying Japanese?

13. What do you expect to learn by participating in this program?

14. Are you planning on continuing your Japanese studies at your university after thisprogram?
□Yes□No
If yes, please specify.

15. Have you taken any courses about Japanese culture or history?
□Yes□No
If yes,a. Course name:b. When:c. Where:d. Course length:e. Textbook(s) used :16. List any academic or research interests you have in your field of study, Japanese
language and culture, or otherwise. This will help us to better understand participants.

17. Is there anything else you think your instructors should know about you or that you
would like to share with your instructors?

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