This is a sample. Access an online application webform on the guideline to apply.
※Receipt #Application Form①（Married couple/Family Room）
To the Head of International Student House
Affix Photo
3×4cm

Name in Katakana

Full Name(Family)(Given)(Middle)*Please write yourEnglish
Date of Birthname in katakana orYearMonthDayalphabet on theNationality

Sex

back of the picture.

Male・Female

I would like to apply for International Student House with attached documents. When my application is permitted,
I hereby pledge that I observe the rules. In case of non-compliance with the rules, I don’t file complaints against
a forced eviction.
Record of Past
□None / □6 months→PrimaryOccupancy□One year / □1 year and 6 months→Secondary（International StudentHouse and Minesawa(International Student House/Minesawa International Student Dormitory : Year
Month〜 YearMonth)International Student
Month〜 YearMonth)(International Student House/Minesawa International Student Dormitory : YearDormitory）
Select Dormitory（only one to select）

YNU Student ID
Status from
October 2023
Scholarship from
October 2023
Department from
October 2023

International Student House（□Married couple room

□Family room）□ No, I don’t have YNU student ID yet.
□ Yes, I have YNU student ID. (present ID period: YM

M□Privately Funded Student （□MEXT*¥/month□Others）□None

Name of Scholarship:Department

ProgramYNU Student ID#Yeardate of result/ passing status

For test-takers Examination#(Y)(As of Oct. 2023)

(M)

～(Y)

(M)

□【 １year 】April 1, 20xx through March 19, 20xx□【6 months】April 1, 20xx through September 20, 20xx
※Students who have lived for 6 months, 1.5years as of Mar. 31, 20xx or research students as of March, 20xx can request
only for 6 months period excluding MEXT.

Present housingsituation□International Student House □Minesawa □Ooka IR □Tokiwadai IR□Other dormitory □Other real estate property in Japan □Outside of Japan【Current address】〒【Phone #】Your currentaddress&parent’s orrelative’s contact
who live in yourhomeland)□Undergraduate Student □Master`s Student □Doctoral Student □Research Student

Period of Enrollment

Period of Occupancy~Y(house)(mobile# in Japan)(mobile# in your country)【Private Email Address】【YNU Email Address】@ynu.jp【Name & mobile phone】Parents or relatives in your home townName:
Relationship:
Phone#:【Address】
Postal Code:1 / 2Country:This is a sample. Access an online application webform on the guideline to apply.

Application Form②＜Family members＞

Name(in Katakana)

Date of Birth【Spouse】
Photo

Sex

Year

MonthMale・Female

Visa Status

Day

（ age

Relationship
Period of pastoccupancy at
Minesawa andInternational StudentHouse*If VISA status is
not ‘Dependent’,submit a copy ofmarriage
certificate.

）

years
monthsName(in Katakana)

Date of Birth【Child】
Photo

Sex

Year

MonthMale・Female

Day

（ age

Relationship
Period of pastoccupancy at International

Visa Status）

years
monthsStudent House
Name(in Katakana)

Date of Birth【Child】
Photo

Sex

Year

MonthMale・Female

Day

（ age

Relationship
Period of pastoccupancy at International

Visa Status）

years
monthsStudent House
Name(in Katakana)【Child】
Photo

Date of Birth
Sex

Year

MonthMale・FemaleDay）

Relationship
Period of pastoccupancy at International

Visa Status（ age

Student House

years
months※Applicants whose spouses are Japanese or spouses’ status of residence is “permanent” or “settlement” are noteligible for family room or room for married couple. If your spouse’s status of residence is other than “dependent”
or “student”, please consult with the contact before applying.
※If the spouse’s visa status is not ‘dependent’, please submit a copy of marriage certificate.
※Family rooms are intended for applicants, spouse and their children to live together throughout the residence period.
Married couple rooms are intended for applicants and spouses living together throughout the residence period.
Applicants with family members having residency status in Japan will be given priority.
※Please attach a copy of your family’s residence card or authorization of resident eligibility to this application form.
※A married couple who is expecting a baby needs to apply for family room not for married couple room.

2 / 2