Self-Introduction Form

Please fill out this form in Japanese as much as possible. Date:

Please underline your family name. PHOTO
Attach photo of yourself taken within the last three months 3

Name Please indicate the pronunciation of your name in katakana if possible. Nickname Sex Date of Birth Year Month Day Nationality Height cm Your mother tongue Other language(s) About your family Have you got any hobbies? What are you good at?

Reasons why you have started to learn Japanese language

Things you want to do, learn about, or study in Japan Previous stays in Japan Have you ever been in Japan?YesNo If yes, where have you been? Mark which you have dietary restrictions due to religious reason with circles.

None Beef Pork Chicken Fish Shrimp Shellfish Egg Dairy Products Alcohol Anything else (Please specify)

Mark None, if you have no restrictions.

Mark which you have dietary restrictions due to allergy with circles.

None Beef Pork Chicken Fish Shrimp Shellfish Egg Dairy Products Alcohol Anything else (Please specify)

Mark None, if you have no restrictions.

Animals you do not like or are allergic to

Anything else (Please specify) None DogCat Bird

Mark None, if you have no restrictions.