写真Photo 3 × 4cm三ヶ月以内に撮影半身、正賞、校帽Taken within 
  3 months, 
half-length, full front face, hatless APPLICANT INFORMATION進学1年6ヶ月(1year 6 months)進学2年（2years）進学1年3ヶ月(1year 3 months)進学1年9ヶ月(1 year 9 months)出生地Birth Place江学名Name in Kanji大学院(Master Degree)大学(University)高校(High Sohool)大事・短期大学(2・3 years College)中事(Technical High School)日本語資格oertification Japanese級Level申請提出先学校名Name of school applied before申請不交付歴Past rejection for Visa SPONSOR INFORMATION中前者との関係
holationhip to applicat現住所Current Home Address戸崎住所Hone  address (Off Iolal ly  registered)会社員(Employee)自害楽(Self Employment) Type of Business我引前年収Incomo before tax進学(Further Education in Japan)帰国(Return back to country)本家族の予定Plans after Kel fuku就職（Work in Japan)その他（Other)個人での申請です(Application personally)この申請はエージェントを通した申請です(Application through an agency) This is theエージェント名Agency's Name本人署名Signature記入日(Date)コースCourse - - - - -国籍  Netionality Home address(Officially registered) E-mail旅券番号a Passport No. (D)泉教学歴Final Education中Score :氏名
氏
元禄電話書券
  Phoneその他(Other) ■ Ocoupation会社役員(Executive) Kano of Employer L年日(3) B)
配偶者の有無
   Married status配偶者氏名Name of Spouse
■日本語学習歴 Japanese education history学校名Name of school所在地Address of school
■職歴・兵役等:就職年月の順に記載Previous Occupations勤務先Name of company所在地Address of campany
■日本出入国歴 Previous stays in Japan在留資格Visa
大学(University)上記の内容に相逢ありません。I hereby declare the above statement is correct  年A B (Y) (M) (D)
童日本国法務大臣国籍Nationality
( )も別Sox私は、この度、上記の者が日本国に在留中・入国した場合の経費支弁者になりましたので、下記のとおり経費支弁の引受け経緯を説明するとともに、経費支弁について誓約します。記
1.経費支弁の引受経緯
(申請者の経費の支弁を引受けた経緯及び申請者との関係について具体的に記載して下さい) 2.経費支弁内容私、は、上記の者の日本国滞在について、下記のとおり経費支弁することを誓約します。また、上記の者が在留期間変更許可申請を行う際には、送金証明書又は本人名義の貯金通帳（送金事実、経費支弁事実が記載されたもの）の写し等で、生活費等の支弁事実を明らかにする書類を提出します。記(1)学費Tuition fee年間Annual (2)生活費Living Expense月額Monthly
円（３）支弁方法（送金・振込等支弁方法を具体的にお書きください。） Means of financial support円
日
経費支弁者(Sponsor's information)住所Address
Signature電話番号
Waseda Keifuku Academy Prior Written notice and consent To all applicants Waseda Keifuku Academy will accept applications after obtaining everyone's understanding while disclosing the following information. Therefore, please confirm that the following content is understood and agreed, please type ❤ in the right □ , then sign and submit the document.つ1. During the enrollment, the Academy will charge the following amounts as tuition fees and other fees. • Screening fee : 2000yen • Entrance fee : 50000yen • Tuition  fees  (1year) ：660000yen • Various expenses  (1year) ：80000yen • Textbook fees: After enrollment, the actual costs for textbooks will be varied according to different classes. In addition, if the tuition is remitted through overseas, the Japanese bank will charge a handling fee of 5,000yen so 5,000yen will be added to the tuition fee request form. 2. According to the "Acceptance Policy for International Students", the tuition fee once paid is non-refundable. However, refunds will only be granted in the following cases. • When applying for a visa at the embassy abroad but not being accepted: ⇒Excluding the screening fee and repayment fee, the entire payment will be refunded. 3. Foreign students in Japan are limited to 28 hours of part-time work per week. The hourly salary is about 1,100 yen, and it is not possible to cover all the tuition and living expenses by part-time job. 4. Japanese language schools attach great importance to attendance. If you do not come to school but only work, your visa may not be extended and you will have to return to your country. 5. Smoking is prohibited and our academy does not accept students who smoke. Suppose you will be fined if you are caught smoking in the academy. 6. Before you come to Japan, please undergo a medical examination such as tuberculosis. If you find a disease or a disease that requires high medical expenses, you may be forced to drop out of school and return to your country. 7. Violation of the law, violation of school rules, poor conduct, poor attendance, etc. will also be punished with withdrawal and expulsion from school. Students who receive these punishments must send back to their country immediately. 8. Other details are written on the recruitment sheets, please read and confirm them. l have understood and agreed with the contents Signature : above.年月山