2019年サマーコース入学願書
Application Form for Summer Intensive Course 2019
漢字名Name in
ChineseCharacters□ Mr. □ Ms.

名前Full Namein English
生年月日
Date of Birth(YYYY/MM/DD)

Age ()

国籍
Nationality

現住所
Present Address

郵便番号
Zip Code

A facial photo is placed here.

電子メール
Email
電話
Phone
職業
Occupation
希望期間□ From July 8 to August 2 (4 weeks)□ From July 8 to July 26 (3 weeks)

Choose Your
Preferred Length□ From July 8 to July 19 (2 weeks)□ From July 8 to July 12 (1 week)

特記事項
Special Notes

IAYスクール規約を読み理解した上で、このコースを申し込みます。
I read and understand the IAY Regulations attached here, and I am applying for the course.

申請者の署名Applicantʼs Signature
申込⽇
Date of Application (YYYY/MM/DD)
保護者の署名Parental Signature(Participants who are 18 years old or younger need to have a signature from a guardian.)

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空港送迎・宿泊の予約依頼書
Application Form for Airport Pick-Up and Accommodations□ Yes (One-way)

空港送迎が必要ですか？(空港送迎料⾦：⽚道1⼈12,000円)
Do you need someone to pick you up from the Chitose airport?
It will cost 12,000 yen for one person for one-way trip.

□ Yes (Round-trip)□ No, I donʼt need it.

IAYに宿泊⼿配を依頼しますか？(宿泊⼿配料：1⼈10,800円)
Do you need IAY to make a reservation for your accommodation?
It will cost 10,800 yen as a handling charge for making a reservation.

□ YES □ NO

宿泊⼿配をIAYにご依頼される場合は、下記のいづれかのパターンからお選びください。
Please choose from one of these accommodation types below that we oﬀer if you need us to make a reservation
for your accommodation during your stay.
ホームスティ (1⽇2,600円・朝⾷と⼣⾷付き)□Homestay

It will cost 2,600 yen per day, including breakfast and supper.
Desired term (YYYY/MM/DD): from//to//.

//.

家具家電付き賃貸マンション (1ヶ⽉70,000円から・⾷事無し)□Condo including furniture and household electronics
It will cost from 70,000 yen per month. No meal provided.)
Desired term (YYYY/MM/DD): from//to寮 (1ヶ⽉73,200円から・朝⾷⼣⾷付き) ※朝⾷⼣⾷の提供は、⽇曜・祝⽇・第5⼟曜⽇・夏季休業⽇を除く。

□Student Dorm with shared bathroom and toilet (⾵呂トイレ共有)

It will cost from 73,200 yen per month, including breakfast and supper except on Sundays, National
Holidays, the 5th Saturday and summer/winter holidays.
Desired term (YYYY/MM/DD): from//to//.

It will cost from 91,200 yen per month, including breakfast and supper except on Sundays, NationalHolidays, the 5th Saturday and summer/winter holidays.
Desired term (YYYY/MM/DD): from//to//.

□Student Dorm with private bathroom and toilet (⾵呂トイレ付き)

シェアハウス (1ヶ⽉50,400円から・⾷事無し)□Share House

It will cost from 50,400 yen per month. No meals provided.)
Desired term (YYYY/MM/DD): from//to//.

空室状況によっては、ご希望に添えない場合があります。
We may not be able to meet your request depending on their room availabilities.

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日本語力自己評価
Self-Evaluation Form for Your Japanese AbilitiesA.

当てはまるものにチェック✔ を⼊れてください。
Check-box(es) that apply to your Japanese abilities.

□ ⽇本語をほとんど勉強したことがない。I have not studied Japanese much at all.
□ 簡単な挨拶やフレーズが⾔える。I can say some simple phrases or greetings in Japanese.
□ ひらがなの読み・書きができる。I can read and write Hiragana letters.
□ カタカナの読み・書きができる。I can read and write Katakana letters.
□ 基本的な⽇本語をある程度理解できる。I have the ability to understand some basic Japanese. (N5)
□ 基本的な⽇本語を理解できる。I have the ability to understand basic Japanese. (N4)
□ ⽇常的な場⾯で使われる⽇本語をある程度理解できる。I have the ability to understand Japanese used ineveryday situations to a certain degree. (N3)

□ ⽇常的な場⾯で使つかわれる⽇本語の理解に加くわえ、より幅広い場⾯で使かわれる⽇本語をある程度理解することができる。I have the ability to understand Japanese used in everyday situations, and in a varietyof circumstances to a certain degree. (N2)B.

どのくらい⽇本語を勉強したことがありますか？当てはまるものにチェック✔ を⼊れてください。
Check-box(es) to tell us how much you have studied Japanese.
1. どのくらいの期間、⽇本語を勉強していますか。How long have you studied Japanese?
□ 学習経験無し Never □ 数ヶ⽉ A few months □ 6ヶ⽉未満 Less than 6 months□ 1年未満 Less than a year □ 1年以上 A year or longer. How many years?

years

2. 使⽤したことがある教科書を教えてください。 Tell me the textbook(s) that you have used.

□ 教科書を使って⽇本語を勉強したことがない。I have never studied Japanese with any textbooks.
3. ⽇本語能⼒検定試験(JLPT)を持っていますか？Tell me which level you have passed Japanese-Language
Proﬁciency Test (JLPT) if you have taken it.

□ N5

□ N4

□ N3

□ N2

□

N1

□ 受けたことがない Never□ 受けたが落ちた I have taken the text but I did not pass. The level I took wasC.

.

学習動機について、当てはまるものにチェック✔ を⼊れてください。
Check-box(es) to tell us what brought you to study Japanese.

□ ⽇本語に興味がある Interested in Japanese language. □ ⽇本⽂化に興味がある Interested in Japaneseculture. □ 家族や親戚や友達が⽇本にいる Have family, relatives and friends who have already been in Japan.

□ ⽇本語⼒アップ To improve my Japanese □ ⽇本の⼤学への進学 To go on to university in Japan.
□ 将来⽇本で働きたい Hoping to work in Japan in the future. □ その他 Other
PLEASE DO NOT FORGET TO SEND US A COPY OF YOUR PASSPORT. THANK YOU.

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