Download APPLICATION FOR KEIO UNIVERSITY SUMMER SCHOOL

Application form for students from the
Association of Pacific Rim Universities
(APRU) member universities
APPLICATION FOR KEIO UNIVERSITY SUMMER SCHOOL
AT UNIVERSITY OF WASHINGTON
INSTRUCTIONS
1. The application should be typewritten, if possible, or neatly handwritten in block letters.
2. Numbers should be in Arabic numerals.
3. All years should be written using the Western Calendar.
4. Proper nouns should be written in full and not be abbreviated.
(Sex)
1. Full name in native language
male
(Family name)
(First name)
(Middle name)
(Family name)
(First name)
(Middle name)
Female
In Roman block capitals
2. Nationality
3. Date of birth
Year
Month
Day
Paste a passport size
photograph of yourself
taken within the past 6
months. Write your name
and nationality in block
letters on the back of the
photo.
Age
4. Present status: the name of the university and the faculty you enroll
5. Present address and telephone number, facsimile number, e-mail address
Present address：
（ 6cm × 4cm ）
Telephone/facsimile number：
E-mail address：
6. Educational background
Higher Education
Name and Address of
Year and Month
Amount of time
Diploma or
School
of Entrance and
spent at the
Degree awarded,
Completion
attended school
Major subject
Name
From
years
and
Undergraduate Level
To
months
Location
Graduate Level
Name
From
years
and
To
months
Location
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7. English language proficiency: Evaluate your level and insert an X where appropriate in the following blanks.
Excellent
Good
Fair
Poor
Listening
Reading
Writing
Speaking
8. Statement of purpose, your goal of this summer school, your study plan
*Person to be notified in applicant's home country in case of emergency:
1） Name in full:
2） Address: with telephone number, facsimile number, e-mail address
Present address：
Telephone/Facsimile number：
E-mail address：
3） Occupation of the Person:
4） Relationship:
Date of application:
Applicant's name（in Roman block capitals）
：
Applicant's signature:
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