資料３－１
英語Japanese Language Education Common Use Survey［１］Foreign Applicant’s Personal Information Form
① Foreign Applicant’s Information
１) Gender①Male ②Female２) Which age group are you in?
①１９y.o. or younger②２０～２９y.o. ③３０～３９y.o.
④４０～４９y.o. ⑤５０～５９y.o. ⑥６０～６９y.o. ⑦７０ y.o. or older
３) What is your nation of origin?
①China ②South Korea ③Philippines ④Brazil ⑤Vietnam⑥United States⑦Peru⑧Thailand⑨Nepal ⑩Taiwan⑪Other（）４) What is your current residency status?
①Special Permanent Resident ②Permanent Resident ③Overseas Education④Technical training⑤Long-term Resident ⑥Married to a Japanese⑦Dependent ⑧Specialist in Humanities・International Affairs ⑨Engineer⑩Skilled Labor ⑪Designated Activities ⑫Married to a Permanent Resident⑬Other５) How long have you been living in Japan?
①6 months or less ②Between 6〜12 months④Between 3〜5 years ⑤Between 5〜10 years⑦15 years or more

③Between 1〜3 years⑥Between 10〜15 years

６) How much longer do you intend to live in Japan?
①６months or less②6〜12 months ③1〜3 Years④3〜5 Years ⑤More than 5 years ⑥I intend on living here permanently⑦Undecided７) Are you employed?
①Yes②No（seeking employment）③No（Not seeking employment）

資料３－１
英語［２］Japanese Learning Form
②Japanese Study※All applicants（１）Japanese Study Experience
１)Have you studied Japanese before?
①Yes

②No

２)Are you studying Japanese now?
（２） Yes（Go to #３，４，８，９） ②No（Go to #５，６，７，８，９）（２）Circumstances of People Studying Japanese※People studying Japanese

３) How are you learning Japanese?。 （Multiple choice allowed）.
.
.
.

①Self-study（Textbook, TV, etc.）②Self-study（Internet, App, etc.）③Correspondence Education④Free of charge classes⑤Fee-induced classes⑥Learning from family⑦Learning through occupation⑧From a (Japanese) friend⑨From non-Japanese friend⑩Listening to nearby conversations⑪Other４) What are you learning Japanese for? （Multiple choice allowed）.

①Necessary for living in Japan ②Socialize with other Japanese③Necessary at work.
④Seek job with better benefits④ Study at a graduate school, university, etc.
⑥Other（３）Non-Japanese Studying People※People not studying Japanese

５) Do you want to study Japanese?
①Yes②I don’t think so６) Why are you currently not learning Japanese?（Multiple choice is allowed）.

①I’ve already studied enough②I’ve no use for it（I can get by using words other than Japanese）③Due to parenting, time does not permit me to study Japanese④Due to work,time does not permit me to learn Japanese⑤I lack sufficient funding for learning Japanese at this point in time
⑥I do not have information for registrable Japanese classes⑦Japanese classes are not available⑧I am not able to make it to Japanese classes on time
⑨I cannot adapt to the teaching methods or curriculum of the classes⑩I do not not any effective study methods for Japanese⑪I’m just not interested in learning Japanese資料３－１
英語７)What type of circumstances would help you want to learn Japanese?（Multiple Choice）①If I could afford the time for it②If I have the money for it③If there are free Japanese classes④If my free time coincides with the class schedule⑤If there are Japanese classes close to where I live
⑥If there are things I want to learn as well as adaptable teaching
methods and curriculum⑦If there are good textbooks as well as learning material⑧If there are TV programs centered around learning Japanese⑨If there are websites and app centered around learning Japanese⑩If there is an educational correspondence program centered around Learning
Japanese.

（４）※全 All applicants８) At what following times do you use Japanese?（Multiple choice allowed）①Talking with neighbors ②Riding the train/bus ③Everyday life & shopping④Government paperwork⑤Post office / Bank paperwork ⑥Seeking employment⑦At work⑧When feeling ill⑨Talking to your teacher⑩Other９) Have you ever had trouble with Japanese? Please choose which experiences within thepast year.
（Multiple choice allowed）①Talking with neighbors ②Riding the train/bus③Everyday life & Shopping④Government paperwork⑤Post office / Bank paperwork ⑥Seeking employment⑦At work⑧When feeling ill⑨When talking to your teacher⑩Other
⑪I've never had trouble資料３－１
英語［３］ Japanese Proficiency Form
③Japanese ability１０) How much Japanese can you understand?
［Hearing］
１．I can understand all news and television programs.
２．I can mostly understand what others are saying
３．I can understand others if they speak slowly
４．I can only comprehend single words
５．I am mostly not able to understand Japanese［Speaking］
１．I can convey my opinion with no problems
２．I can mostly say what I want
３．I can have easy everyday conversations
４．I can a give a simple self introduction and use set phrases to greet people
５．I am mostly not able to speak Japanese［Reading］
１．I can read letters and notices from the government, school, and workplace
２．I can somewhat read letters and notices from the gov’t,school, and workplace
３．I can take information I need from newspapers, magazines,advertisements
andflyers, train station timetables and guide plates/ticker boards
４．Only easy-to-read indicator art i.e. instructions for cooking or garbage disposal
５．I am mostly not able to read Japanese［書く］１．I am able to write work reports, status of my child to teachers, cooking
instructions as well as sentences explaining methods and situations
２．I am able to write sentences introducing my everyday life, my home town,andmy own experiences
３．I am able to write simple notes that stating important matters to coworkers,
teachers and family
４．I am able to write my name, name of my country, and address
５．I mostly am not able to write Japanese