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Please fill in the form. FSC does not accept any application form without a photocopy of Student ID card.

1. Name (block) ( in English and Japanese if possible) Family Name Mr. Ms. Given name 2. Nationality (Country) 3. University in Japan 4. Major (in English and Japanese) 5. Status (Under graduate-1,2,3,4 / Graduate- M1,M2,D1,D2,D3,(D4,..) / Research student /etc) ______ ____________________________________ 6. Address 7. e-mail address / Mobile E-Mail address

2010 FSC Application Form Date

8. Phone (Apartment / Dormitory) 9. Mobile phone 10. First language Second language Additional language

11. When did you come to Japan? 12. How long are you going to stay in Japan? 13. I would like to receive information in English / Japanese. (Which language is convenient for you?) 14. I agree to join CWAJ FSC. whenever I receive a contact. Signature _______________________ *Student ID check ** Mentor
Photocopy of Student ID should be attached with this form.

I promise to contact FSC leader or mentor

date:

by

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