Please submit the Application Form to your International Office. Handwriting is not Saitama University Summer Program 2017 Application Form I. Personal Information _______________ / ________________ / ________________ Name First Middle Family Year Month Day Date of Birth Gender Male Female □ □ Nationality Native Language Present Address Phone Number Email Passport Expiration Date / / Passport Number Visa Assistance Do you need visa assistance to Japan? YES NO □ □ II. Current Academic Status Undergraduate Master Doctor □ □ □ Degree Course Major Sophomore Junior Senior Freshman □ □ □ Grade □ Language of Study III. Others □Native □Non-native English Level ( ) ( ( ) □TOEFL/PBT □TOEFL/iBT □IELTS ( ) □Other English Score Please answer either score if you are Non-native. I hereby certify that the above information is complete and accurate. And when accepted by Summer Program 2017 I shall abide by the regulations of Saitama University and laws of Japan. Signature Date *Please read the next page carefully before you apply. NOTICE 1. Participants in the program are required to purchase travel insurance at their own expense to cover the period of their stay in Japan.
Saitama University Summer Program 2017 Application Form I. Personal Information Name _______________ / ________________ / ________________ First Middle Family Date of Birth Year Month Day Gender □ Male □ Female Nationality Native Language Present Address Email Phone Number Passport Number Passport Expiration Date / / Visa Assistance Do you need visa assistance to Japan? □ YES □ NO II. Current Academic Status Degree Course □ Undergraduate □ Master □ Doctor Major Grade □ Freshman □ Sophomore □ Junior □ Senior Language of Study III. Others English Level □Native □Non-native English Score □TOEFL/PBT ( ) □TOEFL/iBT ( □IELTS ( ) □Other ( ) Please answer either score if you are Non-native. Please submit the Application Form to your International Office. Handwriting is not I hereby certify that the above information is complete and accurate. And when accepted by Summer Program 2017 I shall abide by the regulations of Saitama University and laws of Japan. Signature Date *Please read the next page carefully before you apply. NOTICE 1. Participants in the program are required to purchase travel insurance at their own expense to cover the period of their stay in Japan.