Mini Course - Application Form

If you intend to apply for any other course please click here.

Whenever you write a calendar date - please write the year first, then the month, then the day, in 6 digits. For Example: if you want to write 2015/DECEMBER/21 then write it as 15/12/21 (ie YY/MM/DD). This will ensure that the date will transfer into the database correctly.

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

Please, complete all sections.

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 you did select "- Other nationality -" above,
please answer next two questions:
a) Your nationality:
b) Do you live in Japan?
Date of birth:
Place of Birth:
Marital Status:
Highest level of education completed:
If other please state:
Home Address:

(enter at least one address)
Address in Japan:
(If you don't have an address in Japan, please leave this blank.)
Email Address:
Telephone Number:
Fax number:
Passport No.:
(If you don't have a passport yet, please email it to us later.)
Passport Valid Until:

Course Information

Check in date:
Length of course:
Accommodation preference:
Have you been to Japan before?
Total number of visits:
Total length of stays in Japan:
(an approximation is OK)
Visa status on previous visit(s):

(Tick one or more)
Do you have any family in Japan?
If Yes please give details:
Have you formally studied Japanese before?
Where did you study Japanese?
What texts/materials did you study?
Approximately how many hours of class contact hours did you receive?
What are your main reasons for studying Japanese:

Other Information

Are there any Japanese food dishes you dislike?/Any food allergies?

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.