志望理由書＊受験生本人が日本語で記入してください。

受験生氏名：
１．なぜ、本校を志望していますか。
＊どのような学校生活（学習、部活動、委員会活動、クラス活動などを含む）をしたいと考えているのか、また将来どのようなことをしたいと考えているのかなどをふまえて具体的に書いてください。

２．簡潔に自己ＰＲしてください。
＊スポーツ・コンクール・ボランティアなどの実績を書く場合には、箇条書きで簡潔に記載してください。

KAETSU ARIAKE Junior & Senior High School
2-16-1 Shinonome Koto-ku Tokyo 135-8711 JAPANTEL: +81-3-5564-2111
FAX: +81-3-5564-2160

STUDENTEVALUATIONSHEETTo Student;（学年、名前、保護者名を記入してあなたを良く知っている先生に渡してください。）
Please print out a paper copy of this form.
Print your name and parent's name in the space below and give this form to your Principal,Counselor, English teacher or Homeroom teacher.

Grade:Name of Student:
Name of Parent:

To Principal/Counselor/Teacher;
Please complete the following form by hand, sign and date it, and pass it to the applicant. The
applicant will be responsible for sending this as part of their admissions paperwork. It will be used in theoverall student evaluation but will not become part of the student's permanent record. We thank you foryour cooperation and candor.

Name and Title of Principal/Counselor/Teacher;Academic and Personal Qualities for This Student
1. How long have you known this student?
2. How many students are in the applicant’s entire grade?
3. What are the first three words that come to mind to describe this student?

4. Has this student ever been a disciplinary problem?

Yes □No □Yes □No □If yes, briefly explain, noting any disciplinary action taken.

5. Has this student advanced to the next grade annually?
If no, please explain;

6. How would you rank this student in the following areas compared with students of the same age?
Truly Outstanding (Top 5%)

Excellent

GoodAverage

Below Average☒ Character□□□□□☒ Intellectual Curiosity□□□□□☒ Potential for Growth□□□□□☒ Summary Evaluation□□

□

□

□

7. What are this student’s strengths?

8. In which areas does this student need improvement?

9. Does this student attend class regularly?

Yes □No □10. Is there a problem with tardiness?

Yes □No □If so, please explain;
11. How well does this student accept advice or criticism?

12. If this student handed in a paper late, it would probably be because the student;□Procrastinates□Has many other activities □Student’s work is never late
□Strives for perfection of expression□Lost the rough draft□Other, please explain;
13. Which words best describe this student’s thinking?
□Imitative□Independent□Creative□Other;14. Does this student have any particular interests or affinities you would like to share with us?

15. Is there any other information that would be helpful to us in evaluating the ability of this student toperform at KAETSU ARIAKE Junior & Senior High School?

School Relationship for Parents
Parents are important part of our relationship with this student. Please share with us any thoughts
you have regarding this family.
1. Are you aware of any family circumstances that affect this student’s life at school?

2. Which word(s) best describe the parents in regard to their child?
□Supportive□Demanding□Controlling□Indifferent□Other;Additional Comments if any;

If we have additional questions, may we contact you?
If yes, email;Signature;Yes □No □@Date;

Thank you very much for your time and the information you have provided.

海外在留証明書年月日かえつ有明中・高等学校
学校長

殿
会社または機関所在地：会社または機関名：

役職名及び氏名：印

下記の者は家族（出願者）を伴い、下記の通り海外に在留していたことを証明します。

記
１ 在留期間等（１）保護者

年

月日より年月日まで（２）出願者

年

月日より年月日まで（３）海外在留地名
国名
都市名
２ 保護者・出願者氏名
保護者氏名
出願者氏名

保護者との続柄