SILAC Comprehensive Special Program (SCSP) - Application Form

Whenever you write a calendar date, please write the year first, then the month, then day to insure smooth transfer to our database. Please do not use more than six digits in total (i.e. September 30th 1978 = YY/MM/DD = 78/09/30).

If an error occurs, please contact admissions@yamasa.org.

Personal Information

Family Name (Surname):
Given Name(s):
Middle Name(s):
(If dual nationality, indicate the country of the passport you plan to enter Japan on.)
If other:
Date of birth:
Post Code:
Street name/number:
If other:
Type of visa that I currently hold/intend to hold:
Highest level of education completed:
If other:
Email Address:
Telephone Number:
Passport No.:

Enrollment Information

Start date of course:
How long do you intend to study from your selected start date?

Please note the course ends at last Thursday in September. If you wish to continue your studies after this date, you can switch to SILAC course.
Customized Option A: In addition, you can choose 1 to 5 Private lessons per week for 10 weeks.
If you will pay for this option before the start date, tuition fee per 1 lesson will be 4000 Yen, after this it will cost you 5000 Yen per 1 lesson.
Have you been to Japan before?:
Have you ever studied Japanese before?
If you studied Japanese before, please describe your Japanese ability:

Accommodation Information

Will you require Yamasa's housing office to arrange accommodation for you?

If "No", skip this (Accommodation Information) section.
When do you expect to arrive in Okazaki?
(Note you can change this later.)
If other please explain details.

All rooms are single.
Please contact us if you wish a shared room.
Please select 3 accommodation options.
All 3 options must be different or the form can`t be sent.
What is your first preference for accomodation for your program?
What is your second preference if that isn't available?
What is your third preference if that isn't available?
I need Yamasa to arrange futons/bedding for me.
If Yes:
I will reserve my place by:

If you are taller than 182cm/6ft, please state height:

Homestay Information

At some stage during your studies, would you like to do a homestay or homevisit?

If "No", skip this (Homestay Information) section.
Do you smoke?
Do you mind if there is a smoker in the homestay family?
Are you allergic to animals or do you dislike any pets?
Are there any Japanese food dishes you dislike?/Any food allergies?
Do you have any other allergies or special requests?
Have you any prior experience of homestays?
Would you be willing to travel by bus and/or train if a homestay was located outside Okazaki?

(Please give more details if acceptance depends on how far the homestay is from Yamasa)
What are your main reasons for wishing to participate in the homestay/homevisit program?
Please write a short outline of your hobbies/interests:
Please write a short outline detailing your family, work/school. It is best to include information that can give a family an insight into your lifestyle, personality etc.:

Arrival Information

I will use Yamasa Airport Pickup Service
(This service cost 12 000,- Yen):

Please note that if this box is not checked, the form cannot be sent.
confirm that I have read, fully understand and agree with the Yamasa Institute's privacy policy and cancellation/refund policy.
Please contact admissions@yamasa.org if you require further information.